Crossing the quality chasm

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Committee on Quality Healthcare in America. Institute of Medicine

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  • First Light LLC [email_address] December 19, 2006 Redefining Health Care by Michael E. Porter and Elizabeth Olmsted Teisberg Harvard Business School Press Cover Jacket
  • First Light LLC [email_address] December 19, 2006 Redefining Health Care by Michael E. Porter and Elizabeth Olmsted Teisberg Harvard Business School Press Copyright Page ii CQC
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  • Crossing the quality chasm

    1. 1. 11 Crossing the Quality Chasm A New Health System for the 21st Century I n s t I t u t e o f M e d I c I n e Committee on Quality of Health Care in America
    2. 2. 22 Note: The following cells are excerpted from the book for discussion purposes only. Please refer to the book itself for exact verbiage, references and quotations. Committee on Quality Health Care in America, Institute of Medicine. Crossing the Quality Chasm A New Health System for the 21st Century (Washington, DC: National Academy Press, 2001). jgillis767@aol.com
    3. 3. 33 “Knowing is not enough; we must apply. Willing is not enough; we must do” -- Goethe
    4. 4. 44An Agenda for Crossing the Chasm 1) Commit to a national statement of purpose for the health care system as a whole and to a shared agenda of six aims for improvement that can raise the quality of care to unprecedented levels. 2) Adopt a new set of principles to guide the redesign of care processes. 3) Identify a set of priority conditions for initial focus. 4) Design and implement more effective organizational support processes to make change possible.
    5. 5. 55An Agenda for Crossing the Chasm 5) Create an environment that fosters and rewards improvement by: • Creating an infrastructure to support evidence-based practice. • Facilitating the use of information technology. • Aligning payment incentives. • Preparing the workforce to better serve patients in a world of expanding knowledge and rapid change.
    6. 6. 66Six Aims 1) Safe – avoiding injuries to patients from the care that is intended to help them. 2) Effective – providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding under use and overuse). 3) 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.
    7. 7. 77Six Aims 4) Timely – reducing waits and sometimes harmful delays for both those who receive and those who give care. 5) Efficient – avoiding waste, including waste of equipment, supplies, ideas, and energy. 6) Equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status.
    8. 8. 88Thirteen Recommendations 1) Continually reduce the burden of illness, injury and disability, and continually improve the health and functioning of the people of the United States. 2) Continually pursue the six major aims: health care should be safe, effective, patient-centered, timely, efficient and equitable. 3) Establish monitoring and tracking processes for use in evaluating the progress of the health system in pursuit of the six major aims in recommendation two. The Secretary of the Department of Health and Human Services should report annually to Congress and the President on the quality of health care provided to the American people.
    9. 9. 99Thirteen Recommendations 4) Work together to redesign health care processes in accordance with the following rules: 1) Care based on continuous healing relationships. 2) Customization based on patient needs and values. 3) The patient as the source of control. 4) Shared knowledge and the free flow of information. 5) Evidence-based decision making. 6) Safety as a system property. 7) The need for transparency. 8) Anticipation of needs. 9) Continuous decrease in waste. 10) Cooperation among clinicians.
    10. 10. 1010Thirteen Recommendations 5) Identify not fewer than 15 priority conditions, taking into account frequency of occurrence, health burden and resource use. Convene stakeholders to develop strategies, goals and action plans for achieving substantial improvements in quality in the next 5 years for each of the priority conditions. 6) Establish a Health Care Quality Innovation Fund to support projects targeted at achieving the six aims and improving the priority conditions. Produce a public- domain portfolio of programs, tools and technologies of widespread applicability.
    11. 11. 1111Thirteen Recommendations 7) Convene a series of workshops involving representatives from health care, other industries and the research community to identify, adapt and implement state-of- the-art approaches to addressing the following challenges: • Redesign of care processes based on best practices. • Use of information technologies to improve access to clinical information and to support clinical decision making. • Knowledge and skills management. • Development of effective teams. • Coordination of care across patient conditions, services and settings over time. • Incorporation of performance and outcome measurements for improvement and accountability.
    12. 12. 1212Thirteen Recommendations 8) Establish and maintain a comprehensive program aimed at making scientific evidence more useful and accessible to clinicians and patients. Include federal agencies, professional and health care associations, the academic and research communities, the National Quality Forum and organizations involved in quality measurement and accountability. 9) Make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade.
    13. 13. 1313Thirteen Recommendations 10) Private and public purchasers should examine their current payment methods to remove barriers that currently impede quality improvement, and to build in stronger incentives for quality enhancement. 11) Develop a research agenda to identify, pilot test, and evaluate various options for better aligning current payment methods with quality improvement goals.
    14. 14. 1414Thirteen Recommendations 12) A multidisciplinary summit of leaders within the health professions should be held to discuss and develop strategies for: • Restructuring clinical education to be consistent with the principles of the 21st century health system, including undergraduate, graduate, and continuing education for medical, nursing and other professional training programs. • Assessing the implications of these changes for provider credentialing programs, funding, and sponsorship of education programs for health professionals.
    15. 15. 1515Thirteen Recommendations 13) Fund research to evaluate how the current regulatory and legal systems: • Facilitate or inhibit the changes needed for the 21st century health care delivery system. • Can be modified to support health care professionals and organizations that seek to accomplish the six major aims; health care should be safe, effective, patient-centered, timely, efficient, and equitable.
    16. 16. 1616 The changes needed to realize a substantial improvement in health careThe changes needed to realize a substantial improvement in health care involve the health care system as a whole. The new rules set forth ininvolve the health care system as a whole. The new rules set forth in this report will affect the role, self-image, and work of front-line doctors,this report will affect the role, self-image, and work of front-line doctors, nurses, and all other staff. The new infrastructures needed will challengenurses, and all other staff. The new infrastructures needed will challenge today’s health care leaders – both clinical leaders and management. Thetoday’s health care leaders – both clinical leaders and management. The necessary environmental changes will require the commitment of payers,necessary environmental changes will require the commitment of payers, health plans, government officials, and regulatory and accrediting bodies.health plans, government officials, and regulatory and accrediting bodies. New skills will require new approaches by professional educators….New skills will require new approaches by professional educators…. I n s t I t u t e o f M e d I c I n e Committee on Quality of Health Care in America A New Health System for the 21st Century
    17. 17. 1717 The 21The 21stst century health care system envisioned by the committee –century health care system envisioned by the committee – providing care that is evidence-based, patient-centered, andproviding care that is evidence-based, patient-centered, and systems-oriented – also implies new roles and responsibilities for patientssystems-oriented – also implies new roles and responsibilities for patients and their families, who must become more aware, more participative,and their families, who must become more aware, more participative, and more demanding in a care system that should be meeting their needs.and more demanding in a care system that should be meeting their needs. And all involved must be united by the overarching purpose of reducingAnd all involved must be united by the overarching purpose of reducing the burden of illness, injury and disability in our nation.the burden of illness, injury and disability in our nation. I n s t I t u t e o f M e d I c I n e Committee on Quality of Health Care in America A New Health System for the 21st Century
    18. 18. 1818 “Seize the moment. Whatever you can do or dream you can, begin it. Boldness has genius, power, and magic in it.” -- Goethe
    19. 19. 1919 Veritas jgillis767@aol.com

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