attention to key shortfalls in the performance of the health care system, have led to demonstrable changes in policy, and have helped identify priorities for improving the care delivery system.

More than a decade ago, the IOM released its groundbreaking report To Err Is Human. According to that report, at least 44,000 and perhaps as many as 98,000 people die in hospitals each year as a result of preventable medical errors (IOM, 1999). The report notes that individual error is not the main cause of adverse events; rather, most medical errors are caused by poorly designed systems and processes that fail to prevent adverse events. This report was followed soon after by Crossing the Quality Chasm (IOM, 2001), which highlights the gap between the care that is possible given advances in science and medical knowledge and the care that is routinely received by patients. The report identifies six aims for the health care system: care should be safe, effective, patient-centered, timely, efficient, and equitable (Box 1-1).

Following up on the Quality Chasm report, the IOM conducted a summit on health professions education, releasing the results of this summit in the 2003 report Health Professions Education: A Bridge to Quality. This report cites the need for major changes in health professions education to keep pace with shifts in the nation’s patient population and health care delivery environment and a rapidly expanding evidence base (IOM, 2003a).

In 2004, the IOM launched the Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, which

BOX 1-1
Six Aims of Health Care Improvement

  • 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.

SOURCE: IOM, 2001, pp. 39-40.

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