National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R18
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R19
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R20
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R21
Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. Washington, DC: The National Academies Press. doi: 10.17226/25152.
×
Page R22

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

CROSSING THE GLOBAL QUALITY CHASM: Improving Health Care Worldwide Committee on Improving the Quality of Health Care Globally Board on Global Health, Board on Health Care Services Health and Medicine Division A Consensus Study Report of PREPUBLICATION COPY: UNCORRECTED PROOFS

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the Institute of Global Health Innovation at Imperial College London, Johnson & Johnson, Medtronic Foundation, National Institutes of Health, U.S. Agency for International Development, U.S. President’s Emergency Plan for AIDS Relief, and Wellcome Trust. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/XXXXX Library of Congress Control Number OR Cataloging-in-Publication: Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Crossing the global quality chasm: Improving health care worldwide. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/XXXXX. PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine. Proceedings chronicle the presentations and discussions at a workshop, symposium, or other convening event. The statements and opinions contained in proceedings are those of the participants and have not been endorsed by other participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine. For information about other products and activities of the National Academies, please visit nationalacademies.org/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

COMITTEE ON IMPROVING THE QUALITY OF HEALTH CARE GLOBALLY DONALD M. BERWICK (Co-Chair), Institute for Healthcare Improvement, Boston, Massachusetts SANIA NISHTAR (Co-Chair), Heartfile, Islamabad, Pakistan ANN AERTS, Novartis Foundation, Brussels, Belgium MOHAMMED K. ALI, Emory University, Atlanta, Georgia PASCALE CARAYON, University of Wisconsin–Madison, Madison, Wisconsin MARGARET AMANUA CHINBUAH, PATH, Accra, Ghana MARIO ROBERTO DAL POZ, Instituto de Medicina Social, UERJ, Human Resources for Health, Rio de Janeiro, Brazil ASHISH JHA, Harvard Global Health Institute, Harvard T.H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts SHEILA LEATHERMAN, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina TIANJING LI, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland VINCENT OKUNGU, PharmAccess, Nairobi, Kenya NEERAJ SOOD, Sol Price School of Public Policy, University of Southern California, Los Angeles, California JEANETTE VEGA, Chilean National Health Fund, Santiago, Chile MARCEL YOTEBIENG, Ohio State University College of Public Health, University of Kinshasa, Columbus, Ohio Study Staff MEGAN SNAIR, Study Director (through July, 2018) EESHAN KHANDEKAR, Research Associate SARAH ANNE NEW, Senior Program Assistant JULIE PAVLIN, Director, Board on Global Health, and Study Director (from August 2018) SHARYL NASS, Director, Board on Health Care Services Consultants RONA BRIERE, Arlington, Virginia JENNIE KWON, NAM Fellow, St. Louis, Missouri LIANA WOSKIE, Harvard Global Health Institute, Boston, Massachusetts IRENE PAPANICOLAS, Department of Health Policy, London School of Economics, London, United Kingdom; Harvard Global Health Institute PREPUBLICATION COPY: UNCORRECTED PROOFS v

Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Jeffrey Braithwaite, Macquarie University Helen Burstin, Council of Medical Specialty Societies Mirai Chatterjee, Self-Employed Women’s Association (SEWA) Peter Lachman, International Society for Quality in Health Care (ISQua) Gina Lagomarsino, Results for Development Maureen Lewis, Acesco Global Sanele Madela, Expectra 868 Health Solutions Najmedin Meshkati, University of Southern California Manoj Mohanan, Duke University David Novillo Ortiz, Pan American Health Organization/World Health Organization Raj Panjabi, Last Mile Health Howard B. Rosen, Independent Consultant Aziz Sheikh, The University of Edinburgh Gabe E. Tzeghai, Summit Innovation Labs Harold E. Varmus, Weill Cornell Medical College Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Enriqueta C. Bond, Burroughs Wellcome Fund Partner, and Bradford H. Gray, Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY: UNCORRECTED PROOFS vii

Preface This report minces no words about the magnitude and costs of the “global quality chasm.” Although evidence is scattered and incomplete, the conclusion is inescapable: for billions of people, universal health coverage—the important mainstay of the World Health Organization’s Sustainable Development Goal (SDG) 3—will be an empty vessel unless and until quality improvement, for all nations, becomes as central an agenda as universal health coverage itself. In view of the immense dedication and effort of tens of millions of health care workers worldwide, often against massive obstacles of resource limitations, political and social fragmentation, corruption, collusion, and even threats to personal security, the central assertion that the current system too often fails to provide high-quality care is not to be made lightly or with disrespect. The study committee vehemently rejects the idea that the workforce is generally at fault, neglectful, or uncaring. On the contrary, without doubt, they deserve credit and the world’s gratitude for a large proportion of the extraordinary progress in population health of the Millennium Development Goal (MDG) and early SDG eras. What we do believe, informed by the guiding intellectual framework of this report— “systems thinking”—is that many of these workers, the would-be healers of the world, are ill served by being embedded in and dependent on systems of care that impede excellence rather than supporting it, and that drain their energy rather than nurturing it. Systemic conditions—such as fragmentation, malaligned payment, unclear goals, poor training, unreliable supply chains, burdensome rules, inadequate information flows, lack of useful data, corruption, and fear— prevent even the most willing workforce from carrying out its daily tasks successfully and contributing to the success of the whole system. As a result, patients suffer needlessly; communities squander scarce resources; and the workforce itself becomes frustrated and exhausted as a part of the ill-functioning system. The good news in this report is that all these problems are remediable—indeed, preventable. Foundational, of course, are adequate social investments in health care supplies, personnel, equipment, and space; these are preconditions for excellence. But alone, they do not assure excellence. To mobilize change, system leaders must reassess values, principles, and systems designs. Even in wealthy settings, where resources are abundant, quality can and does fail because of improper care designs and poor systemic conditions, such as those listed above. Keys to success, given adequate resources, lie in modern, evidence-based methods of quality assurance and improvement. They also lie in full-hearted embrace of the new digital age of medical care, and in making sure that the well-being of patients and the integrity of their care journeys are the compass bearings for all that we do. It is leaders, above all, who have the opportunity and responsibility to nurture those methods and to continually reinforce those aims. The committee is convinced, after 1 year of study and reflection, that these values— especially person-centered care—and these systems-based methods hold as much promise in PREPUBLICATION COPY: UNCORRECTED PROOFS

x CROSSING THE GLOBAL QUALITY CHASM low- and middle-income settings as in wealthy ones. This report sets out an agenda for action on policy, management, and clinical care that, we believe, can deliver far better outcomes for the people who depend on us and far more satisfying and respectful conditions of work for those who try to help. This report joins two others from important organizations: one from a consortium of the World Health Organization, the World Bank, and the Organisation for Economic Co-operation and Development, and another from The Lancet Global Health Commission on High Performing Health Systems in the SDG Era. Together, this report and these two sibling efforts offer the entire global health community evidence-based guidance and, we hope, further motivation to engage in comprehensive health care redesign in pursuit of continual quality improvement as a priority equal to what is now, happily, assigned to universal health coverage. The combination can save lives, financial resources, and pride and joy in the workforce, all at the same time. If 2018 has been a year of study and reports on quality, let 2019 and beyond be an era of action on quality. Sania Nishtar, Co-Chair Don Berwick, Co-Chair Committee on Improving the Quality of Health Care Globally PREPUBLICATION COPY: UNCORRECTED PROOFS

Acknowledgments This report would not have been possible without the invaluable contributions from many experts and stakeholders dedicated to global health. The committee would like to thank all of the speakers (whose full names and affiliations are found in Appendix A) and participants who played a role in the public workshops conducted for this study, as well as the many others who provided valued insight and responded to rapid requests for information to accommodate our short and demanding timeline. Many of these contributors are listed below: Joseph Ali, Hopkins Bioethics Monique Mrazek, International Finance Gerald Bloom, Institute of Developmental Corporation (IFC) Studies Kambale Mughuma Joachim, Ministry of Kathryn Coburn, Murphy Cooke Kobrick Health, DRC Mohammed Dalwai, Open Medicine Kanza Muhindo K. Eric, Ministry of Health, Ara Darzi, Imperial College London DRC Wen Dombrowski, Catalzaize Solange Mukuayiranga, Gisenyi Hospital, Kate Ettinger, Mural Institute Rwanda Gianluca Fontana, Imperial College London Camila Murga, Hospital Italiano Buenos Kelsey Flott, Imperial College London Aires Isaac Holeman, Medic Mobile Kasareka Murotso Pius, Ministry of Health, Benoit Kebela Ilunga, Ministry of Health, DRC Democratic Republic of the Congo Isaac Muyonga, ComBaptist at the Center of (DRC) Africa (CBCA) Alain Kakule, Ministry of Health, DRC Zuberi Muvunyi, Ministry of Health, Edward Kamnuhangire, Ministry of Health, Rwanda Rwanda Nathalie Umutoni, Ministry of Health, Yaseen Khan, Open Medicine Rwanda Nardo Manaloto, Catalaize Sam Wambugu, ICF Emmanuel Manazikira, Gisenyi Hospital, Rwanda The committee would also like to thank the sponsors of this study for their generous financial support: Johnson & Johnson, National Institutes of Health, U.S. Agency for International Development, and U.S. President’s Emergency Plan for AIDS with additional support from the Institute of Global Health Innovation at Imperial College London, Medtronic Foundation, and Wellcome Trust. A special thanks and acknowledgment go to the Institute for Global Health Innovation and the National Institute for Health Research Imperial Patient Safety Translational Research Centre for its time and intellectual contribution in planning the PREPUBLICATION COPY: UNCORRECTED PROOFS

ACKNOWLEDGEMENTS committee’s March meeting on the future of health care. We also thank Peter Buckle and colleagues for their white paper testimony on the role of human factors and Alain Labrique for his paper on technology and the future of health care; special thanks also goes to the Harvard Global Health Institute’s Initiative on Global Health Quality for the analysis estimating the burden of poor quality health care and its economic consequences. Finally, deep appreciation goes to staff at the National Academies of Sciences, Engineering, and Medicine for their efforts and support in the report process: Lauren Shern and Maryjo Oster on the Report Review Committee; Greta Gorman and Tina Ritter in the Communications office; Rebecca Morgan and Jorge Torres-Mendoza at the Research Center for their assistance in fact checking the report; and Victor Dzau for his assistance in and support of the project. PREPUBLICATION COPY: UNCORRECTED PROOFS

CROSSING THE GLOBAL QUALITY CHASM (Online Only)

CROSSING THE GLOBAL QUALITY CHASM

BOXES, FIGURES, AND TABLES

Acronyms and Abbreviations ACT artemisinin-based combination therapy ADDO Accredited Dispensing Outlet ADE adverse drug event AFRO African Regional Office (WHO) AGP Abel Gilbert Pont n AI artificial intelligence AMI acute myocardial infarction ANC antenatal clinic ASHA accredited social health activist BCG Bacille Calmette-Guerin BMAT BioMedical Admissions Test BMI body mass index BP blood pressure BPHS Basic Package of Health Services CAUTI catheter-associated urinary tract infection CBHI Community-Based Health Insurance CDS clinical decision support CHW community health worker CIN Clinical Information Network COPD chronic obstructive pulmonary disease CR citizen representative CRISPR clustered regularly interspaced short palindromic repeats CS caesarean section CVD cardiovascular disease DALY disability-adjusted life year DHS Demographic and Health Surveys DNA deoxyribonucleic acid DRC Democratic Republic of the Congo EHIS electronic health information system EHR electronic health record EMRO Eastern Mediterranean Regional Office (WHO) PREPUBLICATION COPY: UNCORRECTED PROOFS

CROSSING THE GLOBAL QUALITY CHASM FDA U.S. Food and Drug Administration FHS Family Health Strategy FMOH Federal Ministry of Health FSI Fragile States Index GBD Global Burden of Disease GDP gross domestic product GPW General Program of Work HCAC Health Care Accreditation Council HCD human-centered design HDA Health Development Army HEW Health Extension Worker HFE human factors and ergonomics HIC high-income country HIE health information exchange HIV/AIDS human immunodeficiency virus/acquired immunodeficiency syndrome HMC Hamad Medical Corporation HMD Health and Medicine Division of The National Academies HPV human papillomavirus ICHOM International Consortium for Health Outcomes Measurement ICT information and communication technology IDB International Development Bank IOM Institute of Medicine IP informal provider ISIS Islamic State in Iraq and Syria ISO International Organisation for Standardization ITU International Telecommunication Union JICA Japan International Cooperation Agency LHCS learning health care system LMIC low- and middle-income country MCH maternal and child health MDG Millennium Development Goal MESH MH Mentoring and Enhanced Supervision at Health Centers for Mental Health MOH ministry of health NAM National Academy of Medicine NASEM National Academies of Sciences, Engineering, and Medicine NCD noncommunicable disease NGO nongovernmental organization NICU neonatal intensive care unit NIH National Institutes of Health NPR National Public Radio NQPS National Quality Policy and Strategy PREPUBLICATION COPY: UNCORRECTED PROOFS

ACRONYMS AND ABBREVIATIONS NQS National Quality Strategy OECD Organisation for Economic Co-operation and Development OOP out-of-pocket ORS oral rehydration salts ORT oral rehydration therapy P4P pay for performance PCA patient-controlled analgesia PDSA Plan, Do, Study, Act PHA Private Hospital Association PHIT Population Health Implementation and Training PMTCT prevention of mother-to-child transmission POC point-of-care PPH postpartum hemorrhage PREM patient-reported experience measure PRI Pachayati Raj Institution PROM patient-reported outcome measure PTSD posttraumatic stress disorder QEWS Qatar Early Warning System RCT randomized controlled trial RSBY Rasthriya Swasthya Bima Yojna SDG Sustainable Development Goal SEIPS Systems Engineering Initiative for Patient Safety SF substandard and falsified SMS short messaging service SPO Structure-Process-Outcome STS sociotechnical system TB tuberculosis TBA traditional birth attendant UHC universal health coverage UN United Nations VAP ventilator-associated pneumonia VAS Vajpayee Arogyashree Scheme WHO World Health Organization YLD years of life lived with disability YLL years of life lost PREPUBLICATION COPY: UNCORRECTED PROOFS

Next: Summary »
Crossing the Global Quality Chasm: Improving Health Care Worldwide Get This Book
×
Buy Prepub | $84.00 Buy Paperback | $75.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally.

Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas.

Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!