As society moves into the age of active knowledge management and sharing, inter-clinician relationships and communities of practice can be directed to support quality improvement efforts within healthcare organizations. It is argued that successful adoption of the processes that are critical to quality improvement is necessary for durable improvements in quality. Knowledge sharing is necessary for supporting the skills in performing activities associated with practice audit, change management and use of the associated technology. This paper introduces the Relationships, Communities, Quality (RCQ) model, which provides a framework for the purpose of conceptualizing how quality improvement in healthcare can be sustained. A variance model is proposed for the evaluation of communities of practice for their value in quality improvement in healthcare.