The past, present and future of health care quality. Urgent need for innovative, external review processes to protect patients.

There are three paths to quality health care standards: the regulatory route, the "learning science" route, and the futuristic "management science" route. The regulatory path leads to punishment and blame. The learning science path splits, with one road leading back to harsh regulations and the other to the halls of academic medicine. And the management science path, while short, will be the road to success as American health care struggles to improve quality and overcome well-publicized and deadly medical errors.