The Richard and Hinda Rosenthal Lectures Spring 2001 Crossing the Quality Chasm (2003) / Chapter Skim
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Overview
Overview
Pages 7-21
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From page 7... ...
I believe the foundation of the work was set in place by the IOM roundtable Ken Shine mentioned. That roundtable really put a stake in the ground in about 1998, drawing on five decades of research 7
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From page 8... ...
Similarly, work here at The National Academies by the National Cancer Policy Board produced a relatively underexposed report, one that has not received anywhere near the attention it should, showing that the average American cancer patient does not receive care even close to the state of the art of modern cancer care. Tens of thousands of cancer patients may well, in my opinion, die as a result of not having access to treatments that are known to cure curable cancers nowadays.
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From page 9... ...
Within days, President Bill Clinton had ordered immediate and far-reaching responses from every governmental agency in the United States that provides or pays for health care. Within weeks, major projects in response had begun in the American Medical Association, the American Hospital Association, and in professional and trade societies throughout the nation.
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From page 10... ...
Our committee did so, and I ask you as well to look at the bigger picture, because, as compelling as the story of improving patient safety has been in the past year and a half, it is actually sort of confusing. It is confusing to realize that the IOM report, To Err Is Human, had one very important feature.
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From page 11... ...
I want to take you through it now. In a lot of ways, the Chasm report follows exactly the same format as the safety report, but it is on a bigger topic, a far larger topic, a more important topic than patient safety.
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From page 12... ...
About half the elderly people in this country still fail to get pneumococcal vaccine, for example, and 50 percent of people still in hospitals with heart attack fail to get simple drugs that help prevent recurrence of heart attack. In this new report, the Chasm report, our committee says that it is time to reduce the rates of overuse and underuse in this country.
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From page 13... ...
The fifth aim we call efficiency, which basically refers to the reduction and elimination of what I call pure waste: unwise use of materials; time; space; energy; and human spirit. I remember arriving at Heathrow airport a few years ago, as the customs official took out a four-part NCR form and a rubber stamp, stamped the first page, stamped the second page, stamped the third page, stamped the fourth page, ripped off the fourth page, and rolled it into a ball and threw it in a wastebasket overflowing at his feet.
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From page 14... ...
The nurse who puts the racemic epinephrine into the nasogastric tube will be censored, put on probation, and possibly fired. That will have no effect whatsoever on the probability that the next infant will have a gastric hemorrhage.
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From page 15... ...
We suggest an overarching aim to the system, as the President's Advisory Commission did, to remind us always that the purpose of the health care system is to continually reduce the burden of illness and disability and to improve the health status and function of the people of the Untied States. We make recommendations with respect to this key area of change.
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From page 16... ...
We frame our recommendations rather complexly in terms of 10 new simple rules for care, guidelines that would help the detail work to occur with fidelity at the microsystem level to allow them to achieve those aims. In many cases, these rules violate current assumptions about the proper conduct of a microsystem.
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From page 17... ...
Wherein, we ask, do health care systems accrue the right to control visiting hours, or to prevent patients from seeing their own medical records or hearing their own laboratory test results? We specifically call, by the way, for free and unfettered access by patients to their own medical records as a routine standard.
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From page 18... ...
We recommend a future system much more mindful of pure waste as poor quality and far better able to cease wasteful activities and habits rather than allow them to accrue like barnacles on the hull of care. This includes an almost entirely wasteful and dysfunctional medical records system, long overdue for a major overhaul.
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From page 19... ...
At the organization level, many of our new simple rules require assets and supports to microsystems that the microsystems cannot arrange themselves. For example, if we want to urge a more proactive systemrecommendation number nine, anticipatory it has to have a memory, rather than a current reactive system.
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From page 20... ...
I have seen that realization emerge in our country at a level I have never before experienced, first around the safety report. I have seen it not just in the United States with the IOM report, but there is a dawning pub
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From page 21... ...
OVERVIEW 21 kc and professional sense of just how good it could be on a worldwide level. It is going to take people who know that the reality is not as it should be, who are not afraid to say so, who know how impoverished blame is as a remedy, and who not only hope for, but intend to, change systems until they can make the promises that they ought to and keep them every single day.
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