Essentials of Nursing Leadership and Management, 5th Edition

134 unit 2 | Working Within the Organization

The IOM and the Committee on the
Quality of Health Care in America

The IOM is a private, nonprofit organization char-
tered in 1970 by the U.S government. The IOM’s
role is to provide unbiased, expert health and scien-
tific advice for the purpose of improving health.
The result of the IOM’s work supports government
policy making, the health-care system, health-care
professionals, and consumers.
In 1998 the IOM National Roundtable on
Health Care Quality released Statement on Quality
of Care (Donaldson, 1998), which urged health-care
leaders to make urgent changes in the U.S. health-
care system. The Roundtable reached consensus in
four areas regarding the U.S. health-care system:

1.Quality can be defined and measured;
2.Quality problems are serious and extensive;
3.Current approaches to QI are inadequate; and
4.There is an urgent need for rapid change.

This IOM statement launched today’s move-
ment to improve quality and safety for the 21st
century U.S. health-care system.
In 1998 the IOM charged the Committee on
the Quality of Health Care in America to develop
a strategy to improve health-care quality in the
coming decade (IOM, 2000). The Committee
completed a systematic review and critique of liter-
ature that highlighted and quantified severe short-
comings in the heath-care system. Its work led to
the series of reports that serves as the foundation
and strategy for health system reform (Box 10-2).
Two in particular,To Err is Human: Building a
Safer Health System (IOM, 2000) and Crossing
the Quality Chasm: A New Health System for the
21st Century (IOM, 2001), provide a framework

upon which the 21st-century health-care system is

being built.

To Err is Human—discussed later in this chapter—

quantified unnecessary death in the U.S. health-

care system and placed emphasis on system failures

as the foundation for errors and mistakes.

According the report, it is the flawed systems in

patient care that often leave the door open for

human error. The report made a series of eight rec-

ommendations in four areas (Box 10-3) that aimed

to decreased errors by at least 50% over 5 years. The

goal of the recommendations was “for the external

environment to create sufficient pressure to make

errors costly to health-care organizations and

providers, so they are compelled to take action to

improve safety” (IOM, 2000, p. 4). The recommen-

dations sparked pubic interest in health-care quality

and safety and caused prompt responses by the

government and national quality organizations.

Crossing the Quality Chasmaddressed broad quality

issues in the U.S. health-care system. The report indi-

cated that the health-care system is fundamentally

flawed with “gaps,” and it proposed a system-wide

box 10-1

Institute of Medicine Priority Areas

(IOM, 2003b).

• Asthma


• Cancer screening


• Care coordination


• Children with special
  care needs


• Diabetes


• End-of-life issues


• Frail elderly


• Health literacy


• Hypertension


• Immunizations
  
  
  • Ischemic heart disease
  
  
  • Major depression
  
  
  • Nosocomial infections
  
  
  • Obesity
  
  
  • Pain control in advanced
    cancer
  
  
  • Pregnancy and childbirth
  
  
  • Self-management
  
  
  • Severe, persistent mental illness
  
  
  • Stroke
  
  
  • Tobacco dependence in adults
  
  
  
  

box 10-2

IOM Quality Reports (IOM, 2006)

• Crossing the Quality Chasm: The IOM Quality Health Care
  Initiative(1996)


• To Err Is Human: Building a Safer Health System(2000)


• Crossing the Quality Chasm: A New Health System for the
  21st Century(2001)


• Envisioning the National Health Care Quality Report(2001)


• Priority Areas for National Action: Transforming Health Care
  Quality(2003b)


• Leadership by Example: Governmental Roles(2003)


• Health Professions Education: A Bridge to Quality(2003a)


• Patient Safety: Achieving a New Standard of Care(2003)


• Keeping Patients Safe: Transforming the Work Environment
  for Nurses(2004)


• Academic Health Centers: Leading Change in the 21st
  Century(2004)


• Preventing Medication Errors: Quality Chasm Series(2006)

box 10-3

Focus Areas of To Err is Human

Recommendations (IOM, 2000)

• Enhance knowledge and leadership regarding safety.


• Identify and learn from errors.


• Set performance standards and expectations for safety.


• Implement safety systems within health-care organ-
  izations.