delivery and health outcomes for any one of the three depends upon improving care delivery and outcomes for the others.

  • The Quality Chasm recommendations for the redesign of health care are as applicable to M/SU health care as they are to general health care.


Crossing the Quality Chasm (IOM, 2001:6) proposes the following statement of purpose for the U.S. health care system:

…to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.

To help achieve this purpose, the Quality Chasm report identifies six dimensions in which the U.S. health care system functions at far lower levels than it could and should, and translates these dimensions into national aims to guide the quality improvement efforts of all health care organizations, professional groups, public and private purchasers, and individual clinicians (see Box 2-1).

To further assist quality improvement efforts, the Quality Chasm report specifies an accompanying set of ten rules to guide the redesign of health care so as to accomplish the six quality aims (see Box 2-2).

BOX 2-1
The Six Aims of High-Quality Health Care

Safe—avoiding injuries to patients from the care that is intended to help them.

Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit.

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.

Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.

Efficient—avoiding waste, in particular waste of equipment, supplies, ideas, and energy.

Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

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