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Ongoing efforts to reduce medical errors and enhance quality of patient care focus primarily on technological innovations. However, important management issues that underlie about two-thirds of adverse events have commanded insufficient attention. Examines two alternative management philosophies--control based and commitment based--premised on opposite sets of assumptions about human motivation, and develops a model linking the overall management philosophy with medical errors and quality of care. The current control-based culture and management systems in health care organizations are inherently inadequate in delivering high-quality patient care and safety. To bring further improvements in clinical outcomes, it is necessary to transform them. Implementing commitment-based management will foster collaboration, communication, coordination, and teamwork--the essential mechanisms for reducing medical errors and rendering high-quality health care.

This articles examines the core competencies of twelve leading multinational companies. It explores their competencies, how they were developed, and how they are shifting over time. Successful companies rely on three types of competencies: superior technological know-how, reliable processes, and close external relationships. Different approaches are needed to develop each type of competency. While these firms have historically relied on technological know-how and reliable processes, they are planning more close external relationships for the future. External relationships help these firms strengthen and extend their traditional competencies while responding to the demands of globalization, mass customization, enhanced quality, and rapid technological change.