Crossing the Quality Chasm
Table of contents
- 1. Aims
- 2. Recommendations
Source: Crossing the Quality Chasm: A New Health System for the 21st Century (2001), Institute of Medicine (IOM)
The committee proposes the following agenda for redesigning the 21st-century health care system:
- That all health care constituencies, including policymakers, purchasers, regulators, health professionals, health care trustees and management, and consumers, commit to a national statement of purpose for the health care system as a whole and to a shared agenda of six aims for improvement that can raise the quality of care to unprecedented levels.
- That clinicians and patients, and the health care organizations that support care delivery, adopt a new set of principles to guide the redesign of care processes.
- That the Department of Health and Human Services identify a set of priority conditions upon which to focus initial efforts, provide resources to stimulate innovation, and initiate the change process.
- That health care organizations design and implement more effective organizational support processes to make change in the delivery of care possible.
- That purchasers, regulators, health professions, educational institutions, and the Department of Health and Human Services create an environment that fosters and rewards improvement by (1) creating an infrastructure to support evidence-based practice, (2) facilitating the use of information technology, (3) aligning payment incentives, and (4) preparing the workforce to better serve patients in a world of expanding knowledge and rapid change.
The committee recognizes that implementing this agenda will be a complex process and that it will be important to periodically evaluate progress and reassess strategies for overcoming barriers.
Aims
The committee proposes six aims for improvement to address key dimensions in which today’s health care system functions at far lower levels than it can and should. Health care should be:
- Safe—avoiding injuries to patients from the care that is intended to help them.
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Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).
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Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
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Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.
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Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy.
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Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
Recommendations
- All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.
- All health care organizations, professional groups, and private and public purchasers should pursue six major aims; specifically, health care should be safe, effective, patient-centered, timely, efficient, and equitable.
- Congress should continue to authorize and appropriate funds for, and the Department of Health and Human Services should move forward expeditiously with the establishment of, monitoring and tracking processes for use in evaluating the progress of the health system in pursuit of the above-cited aims of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The Secretary of the Department of Health and Human Services should report annually to Congress and the President on the quality of care provided to the American people.
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