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veyed by the collective impact of all of our health care quality problems requires the urgent attention of all stakeholders—the health professions, health policy makers, consumer advocates, and purchasers of care. The challenge is to bring the full potential benefit of effective health care to all Americans while avoiding unnecessary and harmful interventions and eliminating preventable complications of care. Meeting this challenge demands a readiness to think in radically new ways about how to deliver health care services and how to assess and improve their quality. Yet neither business leaders, medical leaders, policy makers, nor the public has a clear picture about whether different forms of financing and delivery of care have affected the quality of care and how best to structure financing, oversight, and delivery of care to improve quality.

The methods used for this study included a review of available literature, a commissioned paper, public testimony, a telephone survey, and input from targeted groups on specific issues. A review of the literature relied on published articles focusing on areas of quality, medical errors, patient safety, aviation safety, worker safety, and pharmaceutical safety. Working papers and web sites were also consulted, generally provided by organizations involved in patient safety, accreditation, and existing error reporting systems.

A paper was commissioned on the legal issues raised in protecting data and reporters in error reporting systems that are external to a health care organization. This paper was completed for the committee by Randall Bovbjerg, J.D., and David Shapiro, M.D., J.D. It formed the basis for Chapter 6 of this report.

The content of this report was discussed at seven meetings of two different subcommittees. It was on the agenda at four meetings of the Subcommittee on Creating an External Environment for Quality and three meetings of the Subcommittee on Creating the 21st Century Health System. It was also on the agenda at three meetings of the Committee on Quality of Health Care in America. The public testimony provided follows:

Subcommittee on Creating an External Environment for Quality

November 2, 1998

Martin Hatlie, National Patient Safety Foundation
Michael Cohen, Institute for Safe Medication Practices
Ronald Goldman, Veterans Health Administration



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