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.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA
• Reviewers
• Preface
• Foreword
• Acknowledgments
• Executive Summary
• 1. A New Health System for the 21st Century
  • THE QUALITY GAP
  • UNDERLYING REASONS FOR INADEQUATE QUALITY OF CARE
  • AGENDA FOR THE FUTURE AND ROAD MAP FOR THE REPORT
  • REFERENCES
• 2. Improving the 21st-century Health Care System
  • SIX AIMS FOR IMPROVEMENT
  • A VISION OF FUTURE CARE
  • REFERENCES
• 3. Formulating New Rules to Redesign and Improve Care
  • HEALTH CARE ORGANIZATIONS AS COMPLEX ADAPTIVE SYSTEMS
  • TEN SIMPLE RULES FOR THE 21ST-CENTURY HEALTH CARE SYSTEM
• 4. Taking the First Steps
  • THE VALUE OF ORGANIZING AROUND PRIORITY CONDITIONS
  • APPLICATIONS OF PRIORITY CONDITIONS
  • CRITERIA FOR IDENTIFYING PRIORITY CONDITIONS
  • PROVIDING THE RESOURCES NEEDED TO INITIATE CHANGE
  • REFERENCES
• 5. Building Organizational Supports for Change
  • STAGES OF ORGANIZATIONAL DEVELOPMENT
  • LEADERSHIP FOR MANAGING CHANGE
• 6. Applying Evidence to Health Care Delivery
  • BACKGROUND
  • SYNTHESIZING CLINICAL EVIDENCE
  • USING COMPUTER-BASED CLINICAL DECISION SUPPORT SYSTEMS
  • MAKING INFORMATION AVAILABLE ON THE INTERNET
  • DEFINING QUALITY MEASURES
  • REFERENCES
• 7. Using Information Technology
  • POTENTIAL BENEFITS OF INFORMATION TECHNOLOGY
  • AUTOMATED CLINICAL INFORMATION
  • NEED FOR A NATIONAL HEALTH INFORMATION INFRASTRUCTURE
  • REFERENCES
• 8. Aligning Payment Policies with Quality Improvement
  • INCENTIVES OF CURRENT PAYMENT METHODS
  • BARRIERS TO QUALITY IMPROVEMENT IN CURRENT PAYMENT METHODS
  • ADAPTING EXISTING PAYMENT METHODS TO SUPPORT QUALITY IMPROVEMENT
  • NEED FOR A NEW APPROACH
  • REFERENCES
• 9. Preparing the Workforce
  • CLINICAL EDUCATION AND TRAINING
  • REGULATION OF THE PROFESSIONS
  • LEGAL LIABILITY ISSUES
  • RESEARCH AGENDA FOR THE FUTURE HEALTH CARE WORKFORCE
• Appendix A Report of the Technical Panel on the State of Quality to the Quality of Health Care in America Committee
• Appendix B Redesigning Health Care with Insights from the Science of Complex Adaptive Systems

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 Commonwealth Fund; and the Department of Health and Human Services' Health Care Financing Administration 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.

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.