Crossing the Quality Chasm

Crossing the Quality Chasm: A New Health System for the 21st Century is a landmark report published by the Institute of Medicine (IOM) in 2001. The report builds on the work of the 1999 IOM report, To Err Is Human: Building a Safer Health System, which highlighted the prevalence of medical errors and their impact on patient safety. Crossing the Quality Chasm shifts the focus towards broader health care quality issues, outlining a comprehensive strategy for overhauling the U.S. health care system to achieve significant improvements in quality of care.

Summary

The report identifies six aims for improvement to address the gap between the health care that Americans receive and the care they could receive. These aims are that health care should be:

• Safe - avoiding injuries to patients from the care that is intended to help them.
• Effective - providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit.
• Patient-centered - providing care that is respectful of and responsive to individual patient preferences, needs, and values.
• Timely - reducing waits and sometimes harmful delays for both those who receive and those who give care.
• Efficient - avoiding waste, including waste of equipment, supplies, ideas, and energy.
• Equitable - providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

The report also emphasizes the need for a fundamental redesign of the health care system. This redesign involves changes in seven areas:

1. Health care organizations and professionals should adopt a new set of principles for redesigning care processes based on best practices. 2. The use of information technology (IT) should be expanded to improve access to clinical information and support clinical decision-making. 3. Payment policies should be revised to reward quality improvement. 4. The health care workforce should be retrained to adapt to new roles in a redesigned health care system. 5. Public reporting of quality information should be promoted to enable consumers to make informed choices about their care. 6. Quality improvement efforts should be supported by advancing the science of health care quality measurement and improvement. 7. Collaboration among all stakeholders, including patients, health care providers, payers, and government, should be fostered to facilitate widespread changes in the health care system.

Implementation

Implementing the recommendations of Crossing the Quality Chasm requires concerted efforts from all stakeholders in the health care system. Health care organizations need to adopt a systems approach to care delivery, focusing on process improvement and patient safety. Health care professionals must embrace changes in practice that are informed by the best available evidence. Policymakers and payers must create incentives that align with quality improvement goals. Patients and their families should be engaged as active partners in their care.

Impact

Since its publication, Crossing the Quality Chasm has had a significant impact on health care policy and practice. It has inspired numerous initiatives aimed at improving health care quality and safety. The report's framework and recommendations continue to guide efforts to transform the U.S. health care system into one that is more efficient, effective, and patient-centered.

See Also

• Patient Safety
• Health Care Reform in the United States
• Electronic Health Record
• Health Care Quality