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FEATURE ARTICLE
"The New IOM Report Calls for Major Reform and Reorganization in U.S. Healthcare"



The new report from the Institute of Medicine (IOM) has stated that the healthcare delivery system in the United States is foundering and needs major fixes for "what is now a disjointed and inefficient system."1 In 1999, the IOM published, To Err is Human, shocking both the medical community and the general public by announcing that medical error is the fifth leading cause of death in the United States. More people die from medical error than from car accidents, breast cancer, or AIDS. The latest report, Crossing the Quality Chasm: A New Health System for the 21st Century, again focuses on the dire need for solutions for America's healthcare system, but this time with a wide angle lens looking at broad, sweeping changes that need to occur.

The report calls for Congress to create a fund of one billion dollars to support projects and communication that will make solid, significant changes throughout the health care deliver system. It lists six specific areas to target:2

  1. Care should be safe. Patients should not be harmed by the care that is intended to help them.
  2. Care should be effective, that is, based on sound scientific knowledge.
  3. Care should be patient-centered. It should be respectful and responsive to individual preferences, needs, and values.
  4. Care should be timely. Unnecessary waits and sometimes harmful delays should be reduced.
  5. Care should be efficient, not wasteful of equipment, supplies, ideas, or energy.
  6. Care should be equitable. Care should not vary in quality because of patient characteristics, such as ethnicity or geographic location.

In addition, the report offers the following ten rules:3

Ten Rules for Health Care Reform:

  1. Care based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times (24 hours a day, every day) and that access to care should be provided over the Internet, by telephone, and by other means in addition to face-to-face visits.
  2. Customization based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.
  3. The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision making.
  4. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
  5. Evidence-based decision making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.
  6. Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.
  7. The need for transparency. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among alternative treatments. This should include information describing the system's performance on safety, evidence-based practice, and patient satisfaction.
  8. Anticipation of needs. The health system should anticipate patient needs, rather than simply reacting to events.
  9. Continuous decrease in waste. The health system should not waste resources or patient time.
  10. Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.

Without change, things will only get worse. We encourage you to explore the National Academies overview and press release of the report, and to draw your own conclusions. We'd also like to hear what you think. Please join our discussion forum. Do you have a personal experience with patient safety?

References

1 U.S. Health Care Delivery System Needs Major Overhaul To Improve Quality and Safety, press release available on the National Academies web site.
2 Ibid.
3 Patient Centered Care, an article on the National Academies web site.

Discussion

"The New IOM Report Calls for Major Reform and Reorganization in U.S. Healthcare" talks about the recent Institute of Medicine report titled Crossing the Quality Chasm: A New Health System for the 21st Century. The report calls for major improvements in the US Healthcare system. Senior hospital executives are coping with serious challenges-- declining reimbursement, nursing and pharmacy shortages. What will motivate them to make improved patient safety a priority? Tell us what you think.

We invite you to contribute your response in the Discussion forum located in our Feature section.