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Many collective efforts have been initiated over the last 30 years to drive quality and safety improvement through policy channels. This chapter describes both formalized and innovative efforts that continue to grow out of a need to address health delivery challenges, using organizational structures and alliances whose missions were substantially focused on quality and safety. The list is necessarily broad and incorporates federal agencies as well as professional organizations and alliances. Certainly this list is not exhaustive; the intent has been to include those efforts in which nursing has or needs to have a voice in the formal agenda, solutions, and policy formulations. In addition, this chapter touches on some of the additional opportunities for policy input through regulation and rule‐making that inevitably emerge from massive policy enactment.

This chapter incorporates the result of three decades of effort, including the passage and implementation of the ACA and the many provisions within it that support health care quality and safety. It also speaks to the ongoing efforts to press forward with quality despite many political attempts to end the ACA. It includes other recent policy efforts to advance health and health care that focus on the health disparities that make federal and state efforts to improve quality fragmented at best. Efforts to modify reimbursement and minimize barriers to effective patient care delivery will also be examined.