Despite two decades of effort – targeting care processes, outcomes, and most recently the value of care – progress has been slow in closing the gap between quality and cost in the US healthcare system. It’s time for a new approach focusing on healthcare quality as a business strategy, according to a special issue of the Journal for Healthcare Quality (JHQ), the peer-reviewed journal of the National Association for Healthcare Quality (NAHQ). The journal is published in the Lippincott portfolio by Wolters Kluwer.