"The committee has done an excellent job... [This book] identifies and analyzes with great insight and
clarity deficiencies in the quality of our present medical care delivery system, and it is persuasive in outlining
how the system ought to work. ... The report is thoughtful, painstaking, and totally reasonable."
-- New England Journal of Medicine, August 30, 2001
"...even bolder and farther-reaching than To Err Is Human, the Chasm report essentially extends the findings
of the patient safety report to other important dimensions of quality of care. ... The Committee's strong findings
and bold vision will give new momentum to the processes of change in American health care."
-- Institute for Healthcare Improvement
"I enjoyed reading this book. It is written in an easy-to-follow, friendly-to-the-eyes format. The extensive
bibliography...makes this report an excellent source of reference for healthcare administrators and planners. ...
I would recommend this book as a 'must read' for the younger generation in graduate medical education as what it
outlines could very well be their reality."
-- Aviation, Space, and Environmental Medicine, June 2002
"[This book] should be widely read by people involved in clinical governance... The report manages to express
some challenging concepts clearly and engagingly ...there are ideas here that all clinical governance leads would
find thought-provoking, and indicators towards practical action."
-- Journal of Clinical Governance, 2002
National Academies Press Web Site, Oct., 2002
Summary
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
A NEW HEALTH SYSTEM FOR THE 21ST CENTURY
The Quality Gap
Underlying Reasons for Inadequate Quality of Care
Agenda for the Future and Road Map for the Report
IMPROVING THE 21ST CENTURY HEALTH CARE
SYSTEM
Six Aims for Improvement
A Vision of Future Care
FORMULATING NEW RULES TO REDESIGN AND
IMPROVE CARE
Health Care Organizations as Complex Adaptive Systems
Ten Simple Rules for the 21st Century Health Care System
TAKING THE FIRST STEP
The Value of Organizing Around Priority Conditions
Applications of Priority Conditions
Criteria for Identifying Priority Conditions
Providing the Resources Needed to Initiate Change
BUILDING ORGANIZATIONAL SUPPORTS FOR
CHANGE
Stages of Organizational Development
Key Challenges for the Redesign of Health Care Organizations
Leadership for Managing Change
APPLYING EVIDENCE TO HEALTH CARE DELIVERY
Background
Synthesizing Clinical
