Hello everybody again. In this video segment we are going to be talking about the next landmark paper in quality and safety called Crossing the Quality Chasm A New Health System for the 21st Century. But before we dive into this landmark report, I just want to highlight that this was a landmark report that builds on the first one which we have already gone over call To Err is Human. Just as a reminder that To Err is Human was an Institute of Medicine report published in 1999. It described the extent of preventable harm in hospitals, and it provided a comprehensive strategy for improvement for the U.S. healthcare system. In this second report, Crossing the Quality Chasm which was published in March 2001 again, this builds on that report To Err is Human. It really goes about and sets a minimum expectation that patients should be able to count on based on the best scientific knowledge and quality. And it really describes the difference between the current care and the future care not as a gap but as a chasm that we as a healthcare industry really need to figure out how to cross. The report goes into several factors that they believe are contributing to this quality chasm. First, they describe an unprecedented rate of growth in medical science, knowledge, and technology with this growing rate of knowledge it's very hard for healthcare workers to keep up with and keep in their memory this science and they really felt like technology was not helping the healthcare workers to overcome this knowledge gap with keeping up with this rate of growth. Another contributing factor to the quality chasm, was the growing complexity of healthcare. Not only with the technology that I just described but how people are living longer. And then, also how there's more interventions, more medications. Everything is growing, which is adding a lot of complexity to the care. Another contributing factor is in fact, that the population is living longer. And in this, we have an increased incidence and prevalence of chronic disease but we also have a healthcare system that is primarily devoted to dealing with acute episodic care needs instead of the continuum of care. And we really needed to do a better job with focusing our health system priorities not just in the acute episodic care but in that longitudinal managing chronic disease processes. Finally, they identified another main contributing factor to the chasm as being that our healthcare system is poorly organized. They describe it as being overly complex and uncoordinated, that it was significantly wasted resources, that there were huge unaccountable voids in coverage, that there was a loss of information in hand off across episodes of care. And then, finally that organizations, hospitals and physician groups were operating in silos as opposed to working together to take care of the patient. So with this, they identified six primary aims for improvement to help begin to cross that chasm. First, they said hospitals and the healthcare system need to focus on providing safe care, and they defined that as avoiding injuries to patients from the care that is intended to help them. Another one of their aims for improvement, was to make sure we are providing effective care. And they define that as providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. Another aim, was around patient-centered care and that we needed to be providing care that is respectful of and responsive to the individual patient preferences, needs, and values, and ensuring that the patients values were guiding of our clinical decisions. Next, they said we needed to work on providing timely care, so reducing the waits and sometimes harmful delays for both those who receive care and those who give care. They also described an aim for improvement around be more efficient so that we needed to avoid waste, including the waste of equipment, supplies, ideas, and our energy. And finally, they described the need to improve around providing equitable care. And they defined equitable care as providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. Again, these were described in this 2001 report. And when I think about this today I think we've made some progress but we have not yet tackled all six of these. So after outlining these aims for improvement they thought about how we really needed to significantly redesign the system. And first, they thought we needed to work to apply evidence to healthcare delivery not just in the creation of knowledge but in how we apply that knowledge. And they go on to describe that it takes over 17 years for evidence to go from evidence creation to being provided to patients in a reliable way and they still define and identify that that we are not yet reliable in ensuring that every patient gets the evidence they deserve each and every time they need it. Another big point around redesigning the system was that we really needed to maximize the use of information technology. Again, and back in 91 there was not a lot of use of EMR especially out of hospitals and more importantly out of large academic hospitals. And so they really thought about how we needed to not only maximize EMR use but also how we could maximize the internet and other information technology to make our system more reliable and efficient and a high quality. Finally, they talked about the need to align payment models with quality improvement. So up until this point payment models had been primarily around volume and so we've begun to see since this report was outlined, that we are moving towards payment models that are rewarding hospitals and providers based on quality but we're not there yet and there's a lot more we need to do. But it was a good point and I think we have made some progress here. And finally, they talked about the need to prepare the workforce. So we needed to do more interdisciplinary training because we really had been training in silos. And that we also needed to prepare the workforce as early as when they start their training in their professional schools so that we could be using more evidence based practices and knowing how to maximize the use of the literature to drive practice rather than you know, institutional knowledge that may be passed down from person to person. So the crossing the quality chasm report really outlines where we needed to move forward from To Err is Human. And I really love this quote that they ended with. And that is crossing the quality chasm does not offer a simple prescription because in fact, there really is none. But it does provide a vision of what is possible and a path that can be taken. It won't be an easy road but in fact it will be most worthwhile. So this summarizes the crossing the quality chasm report. I would strongly recommend you read the full report. It's available free. However, if you can't read the full report I recommend you at least read the brief report to get a familiarization with this report. Again, a landmark report published in 2001. Have a great day everybody.
