The pace of health care quality improvement in the United States has been slow. After 2 decades of efforts relying largely on quality measurement and performance-linked payment incentives, Warren Alpert Foundation Professor J. Michael McWilliams, MD, PhD, expresses the need for new ideas and new conversations in the New England Journal of Medicine Catalyst.

As revealed by health care workers’ response to the Covid-19 pandemic, professionalism in health care may be an underused resource. Reframing quality improvement around the linchpin of care delivery — physician agency — could provide much-needed direction by elucidating strategies that address problems of information or motivation when professionals act as agents on their patients’ behalf.

These strategies need not rely on measures. Physicians’ collective ability to observe and learn can be better tapped and their intrinsic motivation better supported. McWilliams discusses the inherent limitations of measure-focused approaches, provides a framework for conceiving a next generation of initiatives that aim to improve care by more productively leveraging professionalism, and offers specific directions for policy and practice.