Historically, many interventions have been studied to improve the quality, safety, and effectiveness of medical care, particularly through the new focus on comparative effectiveness research. Unfortunately, sustained provider and system uptake of these interventions has been severely lacking, to the serious detriment of patient health. The most commonly tried tools to increase uptake, including pay-for-performance, have substantially fallen short of expectations. Moreover, often these interventions are created in highly artificial settings, and we have not come up with ways to implement them in the long-term. The challenge, therefore, is to create sustainable change that impacts care in meaningful ways.