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Opening Ken Shine It is my pleasure to welcome you to this Richard and Hinda Rosenthal Lecture. This is a very special event for us, for many reasons. This lecture series, which began in 1988, was designed to explore issues related to the improvement of health, health care, and health policy. Over the years, it has produced some memorable presentations. A number of these presen- tations have been published, including a particularly notable one by David Eddy, which was published in Health Affairs. The talks have also been published as a series, and many people have found them to be quite use- ful. So to have the series continue is, itself, a great thing. It is also a great event because this is the first lecture that commemorates a permanent endowment of the lecture series. The Richard and Hinda Rosenthal Foun- dation had been supporting these lectures on an annual basis, but recently they have committed a major endowment to allow the series to continue in perpetuity. Associated with the endowment has been the dedication of the Rich- ard Rosenthal Presidential Suite, a third-floor suite of offices for the presi- dent of the Institute of Medicine. Those who have not been by or who have come by at other times, can now see a terrific picture of Richard, as well as a collage of photographs showing him in various activities related to the National Academy of Sciences and Institute of Medicine (IOM). Hinda and Richard have had close relationships with both the Na- tional Academy of Sciences and the Institute of Medicine for a long time. They both were members of the President's Circle, which is an important support group. From Hinda we received an enormous amount of encour- 1

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2 CROSSING THE QUALITY CHASM agement and advice, and from Richard we received mostly advice. Rich- ard was an individual who had very keen analytical skills. He was a ter- rific negotiator, which was reflected both in his success in business and his dealings with philanthropy. He was one of the really fun people I was privileged to get to know. He said, in one of the publications, something I think is a very impor- tant statement, and I quote: "Individuals fortunate enough to receive un- usual benefits from society have the distinct obligation to return mean- ingful, tangible support to that society in the form of creative energy as well as funding." That statement is very significant because, as it suggests, it was not just the money. This creative energy found its way into many, many of the activities that Richard and Hinda have been involved in through the years. Those of you who are active in medicine know that they have endowed a whole series of awards, lectures, and so forth in many, many organiza- tions, as well as programs at Columbia University and elsewhere. I think the medical community, the health community, and the American people need to be very grateful for that. We are also pleased about this special event because I think this may be the first that Hinda's husband, Bernie Rosenberg, has been able to at- tend. Bernie is a very well respected public health official in his own right. Hinda and Bernie first met at their wonderful home in Connecticut in a consultation over a sick swan, and having decided that the swan was prob- ably going to be all right, became interested in each other. We all rejoice in their marriage, and we are also very pleased that Seth Rosenberg and lane Cahoon, members of Bernie's family, are also with us. I could spend the rest of the evening talking about these extraordinary people. I am not going to do that, other than to say, Hinda, it is wonderful to have you here, along with Bernie and the family. We recognize that through the years, your encouragement, your support, and your interest have been of extraordinary value. Moreover, people will be standing here well into the twenty-first century working on issues of health because of what you and the Foundation have done. The ability to memorialize Richard is one of the great joys that all of us share with you in terms of what you both have done. Let me now turn to tonight's program. Marion Ein Lewin will intro- duce our two speakers, Don Berwick and Allen Feezor, but I want to say a word or two about the genesis of the topic and how it relates to the IOM. As you know, the Institute of Medicine, like the National Academies, has a responsibility to respond, when asked, to requests for advice and analysis by government and other organizations. Historically, we have tended to do reports when asked about specific kinds of projects. In the middle 1990s, however, we decided that there were important issues in

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OPENING 3 the American health care system that could not wait for us to be asked. Specifically, we developed an initiative that focused on the quality of health and health care in America. We chose quality, out of the major issues of access and cost, because first we thought it was an issue where an analytical, deliberative, evi- dence-based approach could be effective. There were data. We believed that quality could be measured, and that meant there was an opportunity to say something about it that was not simply political rhetoric or bias, but in fact represented data. We first undertook a roundtable, and one of the interesting things about that roundtable was that it brought people together from industry and from academia, from the private sector and the public sector. Among the members of that roundtable was a fellow named Chuck Buck, who, many of you know, is the health director for General Motors. He became very impressed by the fact that there were real problems in the American health care system, both with quality and with patient safety. It was out of that kind of deliberation that he suggested the so-called "leapfrog group," the group of major corporations interested in health care, should adopt these issues, including patient safety, as a vital agenda for major corpora- tions in the United States. We may hear more about that this evening. But we are very pleased that this deliberative process led to what now are 77 major corporations that have committed themselves to quality of health for the individuals they employ. Subsequently, we established a Committee on Quality of Care in America, chaired by Bill Richardson. Again, you will hear more about that. The committee issued two reports, a report on medical errors and medical patient safety, and the Crossing the Quality Chasm report, which you will hear more about this evening. I happened to be at a meeting this afternoon where I delivered a so- called keynote address about some of our activities, and my presentation and question period was followed by a discussion by Mark McCollum. As you know, Mark, with Ann Phelps, is a principal advisor to the president. It was exciting for me to hear Mark say that he felt the administration was in fact going to be committed to improving the quality of health care in America. He described a 14 percent increase in the budget of ARC, which is not enough, but certainly is a step in the right direction. It is a good place to start the discussions. He described the commitment he and his colleagues in the White House had to aligning reimbursement with qual- ity. He also described a specific agenda with regard to diabetes under Medicare, saying that chronic illness, as you will hear, is one of the prior- ity areas where one can get a significant improvement in quality of health care in America. And he described how the administration, he believes, will work to do that. We see this initiative as continuing. We are planning activities to look

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4 CROSSING THE QUALITY CHASM at information technology in support of quality. Mark was very eloquent in his discussion about liability and tort reform, indicating that he be- lieved this was an important issue for the administration to take on, and he quoted the president as being anxious to address liability reform. As you know, we are planning a series of activities that will have to do with the legal system in the area of quality of care. We also have recently released a report of a committee chaired by Bill Roper on what the criteria ought to be for a national quality report, and you will hear more about that. But again, we want you to know we are committed in the foreseeable future to continuing work in this important area. Finally, the quality area provided an opportunity for us to address other important issues. So after much deliberation within the Institute, we determined that the next major overarching initiative that is, an initia- tive where we would do multiple studies over an extended period of time would be the problem of the uninsured. We are very grateful to the Robert Wood Johnson Foundation, which has given us a grant of $3.7 million to do a series of studies on the uninsured. We are also pleased that they have saved a million dollars in their own bank account to dissemi- nate the results of work on the uninsured in a variety of venues. We will also be launching an overarching set of studies on informa- tion technology in support of health, as well as a study on the future of academic health centers, which is not irrelevant in that we have to get some of these academic health centers to understand that education for health professionals about quality is an essential part of what we do. With that prolonged preamble, thanks again to the Rosenthals, Bernie and his family, and all the rest of you for being here. It is now my pleasure to introduce Marion Ein Lewin, who will introduce our speakers.