• the recognition that effective care must be delivered by collaborations between teams of clinicians and patients, each playing a vital role in the care process.

This report presents a vision for a continuously learning health care system that can leverage these opportunities and recommends priority actions that can be taken to accelerate progress toward that vision.

This study entailed identifying the principal structural, economic, and cultural obstacles to improving health care; reviewing strategies that have been successful to date in transforming care; and assessing the potential consequences of inaction. The actions required will be notable, substantial, and highly disruptive. If these changes do not occur, however, the health care system will continue on its current path. Some patients will receive excellent, world-class care, while too many others will experience unnecessary harm and poor quality. The stress placed on physicians will grow as modern health care becomes ever more complex. At the system level, costs and waste will continue to increase, further taxing national, state, and family budgets. The choice, then, is not whether or when the necessary transformation should be initiated—it is how.

Related Assessments of Others

The scale of actions needed to transform the health care system will require concerted effort on the part of numerous individuals and organizations. Indeed, a variety of organizations have devoted substantial effort to initiatives aimed at improving the safety, effectiveness, patient-centeredness, quality, and value of the health care enterprise. This report is intended to build on this important contextual work. This section highlights several notable examples of these prior initiatives; further examples are noted throughout the report.

One notable initiative aimed at revitalizing the health care system is the Commission on a High Performance Health System, sponsored by the Commonwealth Fund. The goal of this effort is “to promote a high-performing health system that provides Americans with affordable access to high-quality, safe care while maximizing efficiency in its delivery and administration” (The Commonwealth Fund, 2012). Major accomplishments of the Commission include measuring health system performance, highlighting areas for improvement, and recommending strategies for addressing those gaps. A number of the policy options advanced by the Commission are being implemented, in part under provisions of the Affordable Care Act (ACA) of 2010 (The Commonwealth Fund, 2012).

The Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative is an effort to “improve health care quality in targeted communities,



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