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

  2. Cooperation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.

The above rules will lead the redesign effort in the right direction, guiding the innovation required to achieve the aims for improvement outlined earlier. Widespread application of these ten rules, each grounded in both logic and varying degrees of evidence, will represent a new paradigm for health care delivery. As the redesign effort moves forward, it will be important to assess not only progress toward meeting the aims, but also the specific effects attributable to the new rules and to adapt the rules as appropriate.

Design ideas are not enough, however. To initiate the process of change, both an action agenda and resources are needed.

Taking the First Steps

The committee recognizes the enormity of the change that will be required to achieve a substantial improvement in the nation’s health care system. Although steps can be taken immediately to apply the ten rules set forth above to the redesign of 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.

To initiate the process of change, the committee believes the health care system must focus greater attention on the development of care processes for the common conditions that afflict many people. A limited number of such conditions, about 15 to 25, account for the majority of health care services (Centers for Disease Control and Prevention, 1999; Medical Expenditure Panel Survey, 2000; Ray et al., 2000). Nearly all of these conditions are chronic. By focusing attention on a limited number of common conditions, the committee believes it will be possible to make sizable improvements in the quality of care received by many individuals within the coming decade.

Health care for chronic conditions is very different from care for acute episodic illnesses. Care for the chronically ill needs to be a collaborative, multidisciplinary process. Effective methods of communication, both among caregivers and between caregivers and patients, are critical to providing high-quality care. Personal health information must accompany patients as they transition from home to clinical office setting to hospital to nursing home and back.



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