Quality (52) Institute of Medicine report: Crossing the quality chasm

25 June, 2021

The New thematic discussion [ https://www.hifa.org/news/learning-quality-health-services-new-thematic-... ] might benefit from considering the IOM's report "Crossing the Quality chasm" - details below. *** The report includes changes of basic assumptions and values - the patient becomes an active - not passive - participant in the healthcare process. in information governance and in clinical governance. [*see note below]

https://www.ncbi.nlm.nih.gov/books/NBK22857/#:~:text=The%20final%20repor...

I would also recommend the WHO's patient Safety plan 2021 to 2030. https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_10Rev1-en.pdf#:~:text=...

*** Institute of Medicine report: Crossing the Quality Chasm: A new Health System for the twenty first millennium.

"The report finds that the current system is unable to provide safe, high quality care in a consistent manner. It consists of 10 rules to redesign the health system and a series of recommendations, including the allocation of $1 billion by Congress to support reform efforts. Crossing the quality Chasm can be read or ordered on line at www.nap.edu.

"Although it was thought by some that this report would not catch as much attention as the first, it has created quite a splash in the media. Headlines such as "US Health Care System said lacking" and "IT must BE used to reform US Health System" can be found in both the trade and popular press.

"New rules to redesign and improve ca

Private and public health purchasers, health care organisations, clinicians, and patients should work together to redesign health care processes in accordance with the following rules:

1. "Care based on continuing 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. Customisation 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 the 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 when 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 responding to events.

9. Continuous decrease in waste. The health system should not waste resources or patient time.

10. Co-operation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and co-ordination of care.

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT gmail.com

[*Note from HIFA moderator (Neil PW): Thank you Richard. The Institute of Medicine report relates specifically to USA. It would be interesting to compare with approaches for improving quality in other countries. Can any HIFA members share reports relating to other countries?]