This California Management Review article provides a framework for understanding the relationship between organizational management philosophies and how they affect medical errors and the quality of care. The authors describe the assumptions and consequences of control-based management and compare it to commitment-based management. Building on this background, they discuss the human resource practices and behavioral consequences of each approach and suggest how these issues relate to improving clinical patient outcomes. They propose that a commitment-based strategy is necessary in health care, whereas current paradigms favor a control-based approach. Along with existing cultural barriers (eg, hierarchy, silos, and a "caste structure"), the authors argue that a shift to implementing commitment-based philosophies will address these fundamental problems.