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Crossing the Quality Chasm: A New Health System for the 21st Century
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About Crossing The Quality Chasm: A New Health System For
Product Description Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change. From The New England Journal of Medicine The Institute of Medicine's Committee on Quality of Health Care in America has issued its second and final report, Crossing the Quality Chasm: A New Health System for the 21st Century. The committee has done an excellent job, but its report is as noteworthy for what it omits as for what it says. It identifies and analyzes with great insight and clarity deficiencies in the quality of our present medical care delivery system, and it is persuasive in outlining how the system ought to work. But it does not say much about the fundamental causes of those deficiencies. Nor does it address the central question: Can we really ``cross the quality chasm'' in medical care without major reform of the whole system? The committee's earlier report, To Err Is Human: Building a Safer Health System (Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, eds. Washington, D.C.: National Academy Press, 1999), was released in the fall of 1999. The report created an immediate sensation with its estimate of 44,000 to 98,000 deaths annually due to errors in hospital care, which it said were due more to error-prone institutional systems than to mistakes by individual health care workers. Predictably, the report launched a spate of governmental and private projects to study the cause and reporting of such events and the means of preventing them. The committee's second report moves beyond the initial focus on medical mishaps and takes a broader look at other problems with the quality of health care. It suggests, in general terms, a variety of ways in which the effectiveness and efficiency of health care should be improved. The report is thoughtful, painstaking, and totally reasonable, and yet it has attracted much less attention than its predecessor. Why hasn't Crossing the Quality Chasm had more impact? I think there are several reasons. First, it contains nothing nearly so sensational as the claim made in the first report that tens of thousands of deaths are caused by medical errors. Second, most of the problems in our health care system that are identified in the second report have been widely recognized for some time. For example, as important causes of reduced quality, the report cites fragmentation of responsibility and lack of continuity in the care of individual patients. It describes the lack of coordination and communication among providers and between providers and patients. And it faults the system for not sufficiently employing electronic-information technology. It criticizes the system's failure to re
