The quality gap in the management of chronic disease is an issue which must be addressed if we are to achieve sustainability of our health system and optimal health outcomes for Canadians. The delivery of quality care needs to be a fundamental expectation of providers, professional regulators, institutional leaders and senior government leaders. Success in the arena of quality improvement comes from clarity of accountability, "obsessive" tracking and action on key performance indicators, and results-based teamwork. Strong leadership, identification of shared priorities across the country, full transparency, and an engaged public are all key to moving ahead in this critical area of Canadian healthcare.