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Crossing the Quality Chasm: A New Health System for the 21st Century (2001)
Institute of Medicine (IOM)

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National Research Council. "9 Preparing the Workforce." Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001. 1. Print.

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Crossing the Quality Chasm: A New Health System for the 21st Century
  • Legal and Regulatory Issues

    • How can regulatory and other oversight processes be coordinated to reinforce the principles of patient-centeredness, evidence-based practice, and systems thinking? What specific legal and regulatory constraints inhibit changes in processes of care? Where are different types of regulations needed? In what areas can existing regulations be streamlined or reduced?

    • How can greater coordination among licensing boards within an individual state and across states be facilitated? How can the continuing competence of health professionals be assessed and ensured?

    • Can liability reform support the principles of patient-centeredness, evidence-based practice, and systems thinking? Are alternative models, such as enterprise liability, desirable?

    • What is the link between regulation of health professions and quality of care?

    • What are the appropriate links among licensure, accountability, and liability?

  • Workforce Supply

    • Given a greater understanding of the previous issues (e.g., what training is provided, the need for greater flexibility in deploying human resources, and alternative approaches to accountability), what are the implications for the needed supply and mix of health professionals?

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Abraham, Kenneth S. and Paul C.Weiler. Enterprise Medical Liability and the Choice of the Responsible Enterprise. American Journal of Law and Medicine 20(1 & 2):29–36, 1994.

Anderson, Brownell M., ed. A Snapshot of Medical Students’ Education at the Beginning of the 21st Century: Reports from 130 Schools. Academic Medicine 75(9, Suppl), 2000.


Berwick, Donald M., A.Enthoven, and J.P.Bunker. Quality Management in the NHS: The Doctor’s Role—II. BMJ 304:304–8, 1992.

Bisgard, J.Cris, Delta Airlines, Oct. 26, 2000. Personal communication: e-mail.


Cantor, Joel C., Laurence C.Baker, and Robert G.Hughes. Preparedness for Practice: Young Physicians’ Views of Their Professional Education. JAMA 270(9):1035–40, 1993.

Cantor, Joel C., Alan B.Cohen, Dianne C.Barker, et al. Medical Educators’ Views on Medical Education Reform. JAMA 265(8):1002–6, 1991.

Chassin, Mark R. Is Health Care Ready for Six Sigma Quality? Milbank Quarterly 76(4):575–91, 1998.

Christakis, Nicholas A. The Similarity and Frequency of Proposals to Reform U.S. Medical Education: Constant Concerns. JAMA 274(9):706–11, 1995.

Cooper, Richard A., Tim Henderson, and Craig L.Dietrich. Roles of Nonphysician Clinicians as Autonomous Providers of Patient Care. JAMA 280(9):795–802, 1998.

Cromwell, Jerry. Barriers to Achieving a Cost-Effective Workforce Mix: Lessons from Anesthesiology. Journal of Health Politics, Policy and Law 24(6):1331–61, 1999.

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