Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project


Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America.


Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers:




A set of performance expectations for the 21st century health care system.
A set of 10 new rules to guide patient-clinician relationships.
A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality.
Key steps to promote evidence-based practice and strengthen clinical information systems.


Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Table of Contents


Front Matter
Executive Summary
1 A New Health System for the 21st Century
2 Improving the 21st-Century Health Care System
3 Formulating New Rules to Redesign and Improve Care
4 Taking the First Steps
5 Building Organizational Supports for Change
6 Applying Evidence to Health Care Delivery
7 Using Information Technology
8 Aligning Payment Policies with Quality Improvement
9 Preparing the Workforce
Appendix A Report of the Technical Panel on the State of Quality to the Quality of Health Care in America Committee
Appendix B Redesigning Health Care with Insights from the Science of Complex Adaptive Systems
Index