In this day of reliance on research-based clinical practice guidelines, their relationship to clinical decision making deserves to be examined. Research using large samples of human subjects can yield of lot of information about population-wide health and economic benefits of a new drug, but not much about the potential net benefits to an individual patient. Olsson et al study the shift from the laboratory to the individual patient. This shift requires, as the authors state, that the clinician extrapolate the research results to the individual patient. In their provocative article, the authors present Design of Experiments as a tool to "bridge the gap between the population-level observations and context-specific applications."

In his commentary on the foregoing article, Duncan Neuhauser recommends that you try out a do-it-yourself experiment using DOE methodology. He sets out some assumptions and walks the reader through the process. Neuhauser points to the far-reaching results of widespread application of DOE to the evaluation and use of various health care strategies. Health care providers and consumers might begin to think in terms of individualized medical care and the individual's control of his own care, one of Dr Neuhauser's favorite research themes.

Something of a novelty for QMHC appears in the form of a case study with commentaries. The case study, "Dear Chief Executive Officer: A Patient's Perceptions," reflects the experience of an actual patient during his hospitalization for surgery. His observations have drawn analyses and suggestions from David Fine, Chief Executive Officer of St Luke's Episcopal Health System in Houston, Tex; Gary Kalkut, MD, Medical Director of Montefiore Medical Center, New York, NY; and Thomas D. Smith, RN, Senior Vice President for Nursing of Mount Sinai Medical Center, New York, NY.

V. Susan Carroll examines the intimate relationship between nurse and patient in her article, "Is Patient Safety Synonymous With Quality Nursing Care?" Focusing on safety per se and the effective care of the patient, she concludes that they are not synonymous, nor should they be. From the perspective of patient care, safety is one component of good nursing care. The author analyzes the core values that enter into the nurse's performance, and argues that they go far beyond the preservation of safety.

The role of quality improvement learning collaboratives (QILCs) in fostering the improvement of patient care quality is the subject discussed by Ayers et al. These authors report on a study in which qualitative research methods were employed to systematically identify and synthesize characteristics of successful data-driven learning collaboratives. Using expert informant interviews, they studied the structures and processes of successful collaboratives. Among their conclusions is the following: the successes achieved by learning collaboratives demonstrate the favorable potential of such organizations for bringing about improvement in the health care delivery system.

In their editorial, Jonathan P. Casey and Amanda Balshaw-Greer reflect on the impact of differing public policy approaches on access to care in Great Britain's National Health Service.

Jean Gayton Carroll, PhD, Editor