Six Quality 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.

  • Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).

  • Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

  • Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.

  • Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy.

  • Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

Source: IOM, 2001, pp. 5–6.

between engineers and health care professionals. The goal of this partnership is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers, et al.) into a high-performance “system” in which every participating unit recognizes its dependence and influence on every other unit. The report describes the opportunities and challenges to harnessing the power of systems-engineering tools, information technologies, and complementary knowledge in social sciences, cognitive sciences, and business/ management to advance the six IOM quality aims for a twenty-first century health care system.

This NAE/IOM study attempts to bridge the knowledge/ awareness divide separating health care professionals from their potential partners in systems engineering and related disciplines. After examining the interconnected crises facing the health care system and their proximate causes (Chapter 1), the report presents an overview of the core elements of a systems approach and puts forward a four-level model—patients, care teams, provider organizations, and the broader political-economic environment—of the structure and dynamics of the health care system that suggests the division of labor and interdependencies and identifies levers for change (Chapter 2).

In Chapters 3 and 4, systems-engineering tools and information/communications technologies and their applications to health care delivery are discussed. These complementary tools and technologies have the potential of improving radically the quality and productivity of American health care. A discussion of structural, economic, organizational, cultural, and educational barriers to using systems tools and information/communications technologies follows; recommendations are offered for overcoming these barriers. In Chapter 5, the committee proposes a strategy for building a vigorous partnership between engineering and health care through cross-disciplinary research, education, and outreach.


Systems-engineering tools have been used in a wide variety of applications to achieve major improvements in the quality, efficiency, safety, and/or customer-centeredness of processes, products, and services in a wide range of manufacturing and services industries. The health care sector as a whole has been very slow to embrace them, however, even though they have been shown to yield valuable returns to the small but growing number of health care organizations and clinicians that have applied them (Feistritzer and Keck, 2000; Fone et al., 2003; Leatherman et al., 2003; Murray and Berwick, 2003). Statistical process controls, queuing theory, quality function deployment, failure-mode effects analysis, modeling and simulation, and human-factors engineering have been adapted to applications in health care delivery and used tactically by clinicians, care teams, and administrators in large health care organizations to improve the performance of discrete care processes, units, and departments.

However, the strategic use of these and more information-technology-intensive tools from the fields of enterprise and supply-chain management, financial engineering and risk analysis, and knowledge discovery in databases has been limited. With some adaptations, these tools could be used to measure, characterize, and optimize performance at higher

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