In 2001, the IOM published Crossing the Quality Chasm: A New Health System for the 21st Century, which discussed “how the health system can be re-invented to foster innovation and improve the delivery of care. Toward this goal, the committee presented a comprehensive strategy and action plan for the coming decade”. The IOM’s vision included six aims for improvement that defined how health care organizations could change:
· 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, and ensuring that patient values guide all clinical decisions.
· 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.
In order to be able to achieve these aims, the IOM put together a set of 10 rules to use in order to redesign the health care system:
1. Care is based on continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.
2. Care is customized according to patient needs and values. The system should be designed to meet the most common types of needs, but should have the capability to respond to individual patient choices and preferences.
3. The patient is the source of control. Patients should be given the necessary information and opportunity to exercise the degree of control they choose over health care decisions that affect them. The system should be able to accommodate differences in patient preferences and encourage shared decision making.
4. Knowledge is shared and information flows freely. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
5. Decision making is evidence-based. 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 is 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. Transparency is necessary. The system should make available to patients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction.
8. Needs are anticipated. The system should anticipate patient needs, rather than simply react to events.
9. Waste is continuously decreased. The system should not waste resources or patient time.
10. Cooperation among clinicians is a priority. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.
The IOM has been instrumental in reinventing and redesigning the health care system. Much of what is done today was foreseen in the IOM’s papers from 1999 and 2001. The information found in To Err Is Human and Crossing the Quality Chasm is still being followed today to fix a broken health care system. Nurse leaders are tasked with the important role of reengineering health care, as well as implementing change and innovation.