A general model of the influence of the environment on quality, as shown in Figure 1.1, contains two primary dimensions. The first dimension identifies domains of quality. These include: safe care, practice that is consistent with current medical knowledge and customization. The second dimension identifies forces in the external environment that can drive quality improvement in the delivery system. These have been grouped into two broad categories: regulatory/legislative activities, and economic and other incentives.
Safety, the first domain of quality, refers to "freedom from accidental injury." This definition is stated from the patient's perspective. As discussed in chapter 2 of this report, health care is not as safe as it should be.
The second domain refers to the provision of services in a manner that is consistent with current medical knowledge and best practices. Currently,