Conference-at-a-Glance Background This overview summarizes the work presented at The Picker Institute's Sixth Annual Symposium, held in Boston July 13–14, 2000. Issues Health care in the United States may be the most expensive and the best in the world, but according to David M. Lawrence, it is characterized by great variations in quality, high rates of error, inefficiency and waste, and growing consumer concern. The National Forum for Health Care Quality Measurement and Reporting, as Kenneth W. Kizer stated, was established to improve health care quality by promoting the delivery of care that is known to be effective, achieving better health outcomes, and making health care more accessible and more satisfying to consumers. According to Paul D. Cleary, data suggest that although most people still trust their doctors and nurses, overall, as well as the technical quality of their care, they believe that intermediaries, such as health plans and managed care organizations, affect their doctors' priorities and clinical decisions. Lisa I. Iezzoni stated that even modern high-tech medicine has little to offer those who live daily with major and minor functional disabilities. John D. Halamka sees information technology as a critical tool for creating a delivery system capable of supporting the complex production processes that are characteristic of 21st century medicine. Two years before the release of the Institute of Medicine's 1999 report To Err Is Human, the Veterans Health Administration in the Department of Veterans Affairs had already identified safety as a high priority and launched a systemwide Patient Safety Improvement Initiative, as described by James P. Bagian and Jonathan B. Perlin. Case studies Presenters discussed success stories in using information about patients' experiences to target and support improvement efforts. Several participants, such as Charles J. Homer, reported on collaborative data gathering and improvement efforts among many, sometimes competing, health care organizations. Rhonda Clausen and Robert L. Sheridan described a systemwide approach to improvement among the 22 Shriners Hospitals for Children. Charles G. Humble and Troy Sherrill described an intranet site that allows end users to mine patient survey data through custom queries and to generate data relevant to very specific, local interventions. Several presenters discussed how they engage physicians in patient-centered improvement activities. Involving staff in change to improve patient care may also require attending to their own needs, but little is known about the aspects of working life that most affect patients' perceptions of the quality of care.