The need for leadership in health care has never been greater. Transforming the health care system will not be an easy process. But the potential benefits are large as well. Narrowing the quality chasm will make it possible to bring the benefits of medical science and technology to all Americans in every community, and this in turn will mean less pain and suffering, less disability, greater longevity, and a more productive workforce. To this end, the committee proposes the following agenda for redesigning the 21st-century health care system:

  • That all health care constituencies, including policymakers, purchasers, regulators, health professionals, health care trustees and management, and consumers, commit to a national statement of purpose for the health care system as a whole and to a shared agenda of six aims for improvement that can raise the quality of care to unprecedented levels.

  • That clinicians and patients, and the health care organizations that support care delivery, adopt a new set of principles to guide the redesign of care processes.

  • That the Department of Health and Human Services identify a set of priority conditions upon which to focus initial efforts, provide resources to stimulate innovation, and initiate the change process.

  • That health care organizations design and implement more effective organizational support processes to make change in the delivery of care possible.

  • That purchasers, regulators, health professions, educational institutions, and the Department of Health and Human Services create an environment that fosters and rewards improvement by (1) creating an infrastructure to support evidence-based practice, (2) facilitating the use of information technology, (3) aligning payment incentives, and (4) preparing the workforce to better serve patients in a world of expanding knowledge and rapid change.

The committee recognizes that implementing this agenda will be a complex process and that it will be important to periodically evaluate progress and reassess strategies for overcoming barriers.

Establishing Aims for the 21st-century Health Care System

The committee proposes six aims for improvement to address key dimensions in which today’s health care system functions at far lower levels than it can and should. Health care should be:

  • Safe—avoiding injuries to patients from the care that is intended to help them.

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