Crossing the Quality Chasm

360 Pages·2001·1.15 MB·English

Crossing the
Quality Chasm
A New Health System for the 21st Century
Committee on Quality of Health Care in America
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C.
NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the
committee responsible for the report were chosen for their special competences and with regard for
appropriate balance.
Support for this project was provided by: the Institute of Medicine; the National Research
Council; The Robert Wood Johnson Foundation; the California Health Care Foundation; the Com-
monwealth Fund; and the Department of Health and Human Services’ Health Care Financing Admin-
istration and Agency for Healthcare Research and Quality. The views presented in this report are
those of the Institute of Medicine Committee on the Quality of Health Care in America and are not
necessarily those of the funding agencies.
Library of Congress Cataloging-in-Publication Data
Crossing the quality chasm : a new health system for the 21st century / Committee on
Quality Health Care in America, Institute of Medicine.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-309-07280-8
1. Medical care—United States. 2. Health care reform—United States. 3. Medical
care—United States—Quality control. I. Institute of Medicine (U.S.). Committee on
Quality of Health Care in America.
[DNLM: 1. Health Care Reform—methods—United States. 2. Quality of Health
Care—United States. WA 540 AA1 C937 2001]
RA395.A3 C855 2001
362.1′0973—dc21
2001030775
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Copyright 2001 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
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Berlin.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
Shaping the Future for Health
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
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are chairman and vice chairman, respectively, of the National Research Council.
COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA
WILLIAM C. RICHARDSON (Chair), President and CEO, W.K. Kellogg
Foundation, Battle Creek, MI
DONALD M. BERWICK, President and CEO, Institute for Healthcare
Improvement, Boston, MA
J. CRIS BISGARD, Director, Health Services, Delta Air Lines, Inc.,
Atlanta, GA
LONNIE R. BRISTOW, Former President, American Medical Association,
Walnut Creek, CA
CHARLES R. BUCK, Program Leader, Health Care Quality and Strategy
Initiatives, General Electric Company, Fairfield, CT
CHRISTINE K. CASSEL, Professor and Chairman, Department of Geriatrics
and Adult Development, The Mount Sinai School of Medicine,
New York, NY
MARK R. CHASSIN, Professor and Chairman, Department of Health Policy,
The Mount Sinai School of Medicine, New York, NY
MOLLY JOEL COYE, Senior Fellow, Institute for the Future, and President,
Health Technology Center, San Francisco, CA
DON E. DETMER, Dennis Gillings Professor of Health Management,
University of Cambridge, UK
JEROME H. GROSSMAN, Senior Fellow, Center for Business and
Government, John F. Kennedy School of Government, Harvard University,
Boston, MA
BRENT JAMES, Executive Director, Intermountain Health Care Institute for
Health Care Delivery Research, Salt Lake City, UT
DAVID McK. LAWRENCE, Chairman and CEO, Kaiser Foundation Health
Plan, Inc., Oakland, CA
LUCIAN L. LEAPE, Adjunct Professor, Harvard School of Public Health,
Boston, MA
ARTHUR LEVIN, Director, Center for Medical Consumers, New York, NY
RHONDA ROBINSON-BEALE, Executive Medical Director, Managed Care
Management and Clinical Programs, Blue Cross Blue Shield of Michigan,
Southfield
JOSEPH E. SCHERGER, Associate Dean for Primary Care, University of
California, Irvine College of Medicine
ARTHUR SOUTHAM, President and CEO, Health Systems Design,
Oakland, CA
MARY WAKEFIELD, Director, Center for Health Policy, Research, and
Ethics, George Mason University, Fairfax, VA
GAIL L. WARDEN, President and CEO, Henry Ford Health System,
Detroit, MI
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Study Staff
JANET M. CORRIGAN
Director, Quality of Health Care in America Project
Director, Board on Health Care Services
MOLLA S. DONALDSON, Project Codirector
LINDA T. KOHN, Project Codirector
SHARI K. MAGUIRE, Research Assistant
KELLY C. PIKE, Senior Project Assistant
Auxiliary Staff
ANTHONY BURTON, Administrative Assistant
MIKE EDINGTON, Managing Editor
JENNIFER CANGCO, Financial Advisor
Consultant/Editor
RONA BRIERE, Briere Associates, Inc.
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Reviewers
The report was reviewed by individuals chosen for their diverse perspectives
and technical expertise in accordance with procedures approved by the National
Research Council’s Report Review Committee. The purpose of this independent
review is to provide candid and critical comments to assist the authors and the
Institute of Medicine in making the published report as sound as possible and to
ensure that the report meets institutional standards for objectivity, evidence, and
responsiveness to the study charge. The content of the review comments and the
draft manuscript remain confidential to protect the integrity of the deliberative
process. The committee wishes to thank the following individuals for their par-
ticipation in the report review process:
TERRY CLEMMER, Intermountain Health Care, Salt Lake City, UT
SUSAN EDGMAN-LEVITAN, The Picker Institute, Boston, MA
ANN GREINER, Center for Studying Health System Change, Washington, D.C.
DAVID LANSKY, The Foundation for Accountability, Portland, OR
DAVID MECHANIC, Rutgers, The State University of New Jersey,
New Brunswick, NJ
L. GORDON MOORE, Brighton Family Medicine, Rochester, NY
DAVID G. NATHAN, Dana-Farber Cancer Institute (Emeritus), Boston, MA
VINOD K. SAHNEY, Henry Ford Health System, Detroit, MI
WILLIAM STEAD, Vanderbilt University, Nashville, TN
EDWARD WAGNER, Group Health Center for Health Studies, Seattle, WA
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viii REVIEWERS
Although the reviewers listed above have provided many constructive comments
and suggestions, they were not asked to endorse the conclusions or recommenda-
tions nor did they see the final draft of the report before its release. The review of
this report was overseen by WILLIAM H. DANFORTH, Washington Univer-
sity, St. Louis, Missouri, and EDWARD B. PERRIN, University of Washington
and VA Puget Sound Health Care System, Seattle, Washington. Appointed by
the National Research Council and the Institute of Medicine, they were respon-
sible for making certain that an independent examination of this report was
carried out in accordance with institutional procedures and that all review com-
ments were carefully considered. Responsibility for the final content of this
report rests entirely with the authoring committee and the institution.
Preface
This is the second and final report of the Committee on the Quality of Health
Care in America, which was appointed in 1998 to identify strategies for achieving
a substantial improvement in the quality of health care delivered to Americans.
The committee’s first report, To Err Is Human: Building a Safer Health System,
was released in 1999 and focused on a specific quality concern—patient safety.
This second report focuses more broadly on how the health care delivery system
can be designed to innovate and improve care.
This report does not recommend specific organizational approaches to
achieve the aims set forth. Rather than being an organizational construct, rede-
sign refers to a new perspective on the purpose and aims of the health care
system, how patients and their clinicians should relate, and how care processes
can be designed to optimize responsiveness to patient needs. The principles and
guidance for redesign that are offered in this report represent fundamental changes
in the way the system meets the needs of the people it serves.
Redesign is not aimed only at the health care organizations and professionals
that comprise the delivery system. Change is also required in the structures and
processes of the environment in which those organizations and professionals
function. Such change includes setting national priorities for improvement, cre-
ating better methods for disseminating and applying knowledge to practice, fos-
tering the use of information technology in clinical care, creating payment poli-
cies that encourage innovation and reward improvement in performance, and
enhancing educational programs to strengthen the health care workforce.
The Quality of Health Care in America project is supported largely by the
income from an endowment established within the Institute of Medicine by the
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