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Focus on Quality

The IOM report “To Err is Human” was an initial wake-up call that the technically advanced U.S. health care system was frequently deadly. This seminal report demonstrated a need for change. That change led to conversations and activities that would change structures and processes to enhance patient safety. The system was simply designed in a manner that was dangerous and was harming patients. This work continues on today.

The 2001 IOM report “Crossing the Quality Chasm” built on the foundation of “To Err is Human” but shifted the focus to a broader perspective and definition of quality. This definition of quality resonates today and continues to provide the guidepost for healthcare systems on the journey of ongoing improvement in care. According to the report, to deliver quality care a health system must be:

  1. Safe—A health care system should not cause harm. It is unacceptable to have a system that does not recognize or correct avoidable events that harm the patient.

  2. Effective—Evidence-based medicine (i.e., the concept that the decisions shaping the health care of Americans will be grounded in a reliable evidence base1) should be implemented at the patient, population, and health system levels.

  3. Efficient—A health care system needs to address the cost of care and avoid the creation of incentives for overuse.

  4. Timely—A health care system needs to prioritize services related to the patient and address delays in services that potentially affect outcomes and cause undue stress for patients.

  5. Patient centered—Patients should be engaged in health care decision making. Their values and beliefs should be incorporated into care planning.

  6. Equitable—Patients of all races, cultures, and genders should have equal access to health care services. All efforts should be undertaken to reduce and eliminate disparities to access and delivery of care.

References

1. Institute of Medicine. 2008. Evidence-based medicine and the changing nature of health care: 2007 IOM annual meeting summary. Washington, DC: The National Academies Press.

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