Back to Front PageVOLUME 6, NUMBER 4

IOM Report Calls for Health Care System Overhaul

By Jennifer Proctor

"The U.S. health care system is in need of fundamental change." So concludes William Richardson, Ph.D., and his Institute of Medicine (IOM) committee in their report "Crossing the Quality Chasm: A New Health System for the 21st Century."

Dr. Richardson is the president of the W. K. Kellogg Foundation and chair of the IOM Committee on the Quality of Health Care in America, which has been working since 1998 to develop a strategy to substantially improve health care quality over the next decade.

The committee’s sweeping new report has implications for medical schools and teaching hospitals as well as the rest of the health care system. "It recommends big changes for everyone in the health care enterprise, including academic medicine," stresses Donald Berwick, M.D., a committee member and president and CEO of the Institute for Healthcare Improvement. "No one can be left behind."

Among the report’s recommendations are:

• All health care constituencies, including policy-makers, purchasers, and health professionals, should commit to a national statement of purpose and the following six aims for health care: safety, effectiveness, responsiveness to patients, timeliness, efficiency, and equity. Congress should establish a $1 billion "health care quality innovation fund" aimed at achieving these six goals.
• Providers, patients, and health care organizations should adopt a set of principles — "designed first and foremost to serve the needs of the patient" — to enhance patient-provider relationships. These include basing care on continuous healing relationships, cooperation among clinicians, and evidence-based decision-making.
• The Agency for Healthcare Research and Quality should identify 15 or more common chronic health conditions that are associated with much of the nation’s health care burden and expenditures. The agency should then fund research on better caring for these conditions.
• Health care organizations should develop and implement more effective organizational processes, such as those that utilize information technology and care teams.
• HHS, health care organizations, purchasers, and educational institutions should work to change the health care environment by effecting transformations in four areas: broader dissemination of scientific knowledge to encourage evidence-based practice; the building of an information technol-ogy infrastructure for the health enterprise; the alignment of payment policies with quality improvement; and preparation of the work force.

"The implications of this report are profound," Dr. Berwick stresses. While the report’s recommendations are presented to all with an interest in the health care enterprise, he says, medical educators should especially consider the concepts associated with provider professionalism.

"Crossing the Quality Chasm" is the second report of the IOM Committee on the Quality of Health Care in America to make recent headlines. In November 1999, the committee released "To Err Is Human: Building a Safer Health System," which exposed a lack of patient safety in the United States.

In both reports, the IOM has stressed that, however dysfunctional, the system is not beyond redemption. "American health care is beset by serious problems, but they are not intractable," Dr. Richardson says. "Better care is within our grasp."

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18 May 2001