Advancing the Quality and Safety of Care

While the history of the patient safety movement can be traced back to Hippocrates’ famous dictum primum non nocere some 2500 years ago, the more modern safety effort was galvanized by the Institute of Medicine’s (IOM) 1999 landmark report To Err Is Human. The most quoted statistic from this report, that between 44,000 and 98,000 Americans die each year as a result of medical error, was based upon studies of hospital mortality in Colorado, Utah, and New York and extrapolated to an annual estimate for the country. The IOM followed up this report with a second publication, Crossing the Quality Chasm, in which they said, “Health care today harms too frequently, and routinely fails to deliver its potential benefits…. Between the health care we have and the care we could have lies not just a gap, but a chasm.” These two reports have served as central elements in an advocacy movement that has engaged stakeholders across the continuum of our healthcare delivery system and changed the nature of how we think about the quality of care we provide, and receive.

 

In Crossing the Quality Chasm, the IOM included a simple but elegant definition of the word “Quality” as it applies to health care. They defined six domains of healthcare quality: (1) SAFE—free from preventable harm, (2) EFFECTIVE—optimal clinical outcomes; doing what we should do, not what we should not do according to the evidence, (3) EFFICIENT—without waste of resources—human, financial, supplies/equipment, (4) TIMELY—without unnecessary delay, (5) PATIENT/FAMILY CENTERED—according to the wishes and values of patients and their families, (6) EQUITABLE—eliminating disparities in outcomes between patients of different race, gender, and socioeconomic status.

In the years since these two reports were published, the multiple stakeholders concerned about the effectiveness, safety, and cost of health care in the United States, and indeed throughout the world, have accelerated their individual and collective involvement in analyzing and improving care. In the United States, numerous governmental agencies, large employer groups, health insurance plans, consumers/patients, healthcare providers, and delivery systems are among the key constituencies calling for and working toward better and safer care at lower cost. Similar efforts are occurring internationally. Indeed, the concept of the Triple Aim is now being promoted as an organizing framework for considering the country’s overall healthcare improvement goals.