Sick To Death > Chapter 4 > Perspective - The Case for Reforming U.S. Health Care

Sick To Death book cover This extract from the online edition of Sick to Death and Not Going to Take It Anymore! is used with permission.

Perspective - The Case for Reforming U.S. Health Care

Committee on Quality of Health Care in America, Institute of Medicine

The American health care delivery system is in need of fundamental change. . . . Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge. Yet there is strong evidence that this frequently is not the case. . . . Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.

The health care system as currently structured does not, as a whole, make the best use of its resources. . . . What is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns, or toward applying advances in information technology to improve administrative and clinical processes. . . . For several decades, the needs of the American public have been shifting from predominantly acute, episodic care to care for chronic conditions. Chronic conditions are now the leading cause of illness, disability, and death; they affect almost half of the U.S. population and account for the majority of health care expenditures.

The committee is confident that Americans can have a health care system of the quality they need, want, and deserve. But we are also confident that this higher level of quality cannot be achieved by further stressing current systems of care. The current care systems cannot do the job. Trying harder will not work. Changing systems of care will.

The committee proposes six aims for improvement to address key dimensions in which today's health care system functions at considerably lower levels than it can and should. Health care should be:

The committee recognizes the enormity of the changes that will be required to achieve a substantial improvement in the nation's health care system. Although steps can be taken immediately to . . . redesign . . . health care, widespread application will require commitment to the provision of evidence-based care that is responsive to individual patients' needs and preferences. Well- designed and well-run systems of care will be required as well. These changes will occur most rapidly in an environment in which public policy and market forces are aligned and in which the change process is supported by an appropriate information technology infrastructure. . . .

...[C]are that is responsive to patient needs and makes consistent use of the best evidence requires far more conscious and careful organization than we find today.

Organizations will need to negotiate successfully six major challenges. The first is to redesign care processes to serve more effectively the needs of the chronically ill for coordinated, seamless care across settings and clinicians and over time. ...A second challenge is making effective use of information technologies. ...A third challenge is to manage the growing knowledge base and ensure that all those in the health care workforce have the skills they need. ...A fourth challenge for organizations is coordination of care across patient conditions, services, and settings over time. . . . A fifth challenge is to continually advance the effectiveness of teams. . . . Finally, all organizations - whether or not health care related - can improve their performance only by incorporating care process and outcome measures into their daily work. Use of such measures makes it possible to understand the degree to which performance is consistent with best practices, and the extent to which patients are being helped. . . .

To enable the profound changes in health care recommended in this report, the environment of care must also change. ...Two types of environmental change are needed:

The changes needed to realize a substantial improvement in health care involve 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, nurses, and other staff. . . .

American health care is beset by serious problems, but they are not intractable. Perfect care may be a long way off, but much better care is within our grasp. The committee envisions a system that uses the best knowledge, that is focused intensely on patients, and that works across health care providers and settings. . . . The committee believes that achieving such a system is both possible and necessary.

Adapted with permission from Institute of Medicine. 2001. Crossing the quality chasm: a new health system for the twenty-first century. Committee on Quality of Health Care in America, Institute of Medicine, ed. Washington, DC: National Academies Press, pp. 1–21.