For many patients, important health services are de livered by a process of care that spans several service organizations. Issues influencing the quality of care de livered across organizations are infrequently discussed in the health care quality literature. In this paper, inter organizational quality problems that detract from the care received by children with spina bifida, lead poison ing, and children who have been sexually abused are identified. Using concepts from the organizational be havior literature, both structural and group process ap proaches to addressing these problems are discussed to enhance the care received by children. A broader conceptualization of care delivery is required if patients whose care spans institutions are to benefit from qual ity improvement efforts. © 1995, Sage Publications. All rights reserved.