• If shopping were like health care, product prices would not be posted, and the price charged would vary widely within the same store, depending on the source of payment.
  • If automobile manufacturing were like health care, warranties for cars that require manufacturers to pay for defects would not exist. As a result, few factories would seek to monitor and improve production line performance and product quality.
  • If airline travel were like health care, each pilot would be free to design his or her own preflight safety check, or not to perform one at all.

The point is not that health care can or should function in precisely the same way as all other sectors of people’s lives—each is very different from the others, and every industry has room for improvement. Yet, if some of the transferable best practices from banking, construction, retailing, automobile manufacturing, flight safety, public utilities, and personal services were adopted as standard best practices in health care, the nation could see patient care in which

  • records would be immediately updated and available for use by patients;
  • care delivered would be proven reliable at the core and tailored at the margins;
  • patient and family needs and preferences would be a central part of the decision process;
  • all team members would be fully informed in real time about each other’s activities;
  • prices and total costs would be fully transparent to all participants;
  • payment incentives were structured to reward outcomes and value, not volume;
  • errors would be promptly identified and corrected; and
  • results would be routinely captured and used for continuous improvement.

Unfortunately, these are not features that would describe much of health care in America today. Health care can lag behind many other sectors with respect to its ability to meet patients’ specific needs, to offer choice, to adapt, to become more affordable, to improve—in short, to learn. Americans should be served by a health care system that consistently delivers reliable performance and constantly improves, systematically and seamlessly, with each care experience and transition.

In the face of these realities, the Institute of Medicine (IOM) convened the Committee on the Learning Health Care System in America to explore



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