Recommendation 7: The Agency for Healthcare Research and Quality and private foundations should convene a series of workshops involving representatives from health care and 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 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

To achieve the six aims identified in Chapter 2, board members, chief executive officers, chief information officers, chief financial officers, and clinical managers of all types of health care organizations will need to take steps to redesign care processes. The recommended series of workshops is intended to serve multiple purposes: (1) to help communicate the recommendations and findings of this report and engage leaders and managers of health care organizations in the pursuit of the aims, (2) to provide knowledge and tools that will be helpful to these individuals, and (3) to encourage the development of formal and informal networks of individuals involved in innovation and improvement.


The design of health care organizations can be conceptualized as progressing through three stages of development to a final stage that embodies the committee’s vision for the 21st-century health care system, as represented by the six aims set forth in Chapter 2 (see Table 5–1). Although settings and practices vary, the committee believes much of the health sector has been working at Stages 2 and 3 over the last decade or more. As knowledge and technologies continue to advance and the complexity of care delivery grows, the evolution to Stage 4 will require that Stage 3 organizations accelerate efforts to redesign their approaches to interacting with patients, organizing services, providing training, and utilizing the health care workforce.

Stage 1

Stage 1 is characterized by a highly fragmented delivery system, with physicians, hospitals, and other health care organizations functioning autonomously.

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