Making Health Care Better, a piece by David Leonhardt in today's New York Times magazine, is simply a must-read for understanding the complex relationships that shape healthcare quality.
Here is an illustration, based on Don Berwick's "Level of Interest," that often helps me identify players, understand where they're seated, and anticipate where (and why) to expect push-back.
Berwick wrote the piece this slide is drawn from as a "user's guide" for people who would be leading improvement efforts in the aftermath of the IOM report "Crossing the Quality Chasm."
It's worth considering where the elements (drivers; incentives; methodologies) described and critiqued in the Intermountain system fit into Berwick's original construct. (This a case where the expression "same stuff, different decade" is not a slam, but rather a chance to see the evolution of welcome change.)
A better case for a system-approach to healthcare improvement cannot be made than what you'll find in the New York Times piece.
Read it. More importantly, learn from it.