Patients' experiences: fundamental source of the definition of "quality"

A User's Manual For The IOM's 'Quality Chasm' Report

Patients' experiences should be the fundamental source of the definition of "quality."

by Donald M. Berwick

PROLOGUE: The Institute of Medicine (IOM), one of the three bodies that make up the U.S. National Academy of Sciences, has a distinguished history of publishing weighty reports on important subjects that gather more dust on shelves then they often deserve. One such recent IOM report, Crossing the Quality Chasm, is gathering little dust, but penetrating it is a challenge. It calls for nothing less than a redesign of the US health care system.

One of the architects of the report, Donald Berwick, decided that it would be worthwhile to condense the message into a “user’s manual” for interested readers in the United States and abroad. In this paper he synthesizes the report’s structural themes and presents them, executive summary–style, as a framework that did not appear in the final report but was the basis for the months of discussion that led up to the report’s writing and dissemination. This framework comprises four levels of interest: the experience of patients (Level A), the functioning of small units of care delivery (or “microsystems”) (Level B); the functioning of the organizations that house or otherwise support Microsystems (Level C); and the environment of policy, payment, regulation, accreditation, and other such factors (Level D) that shape the behavior, interests, and opportunities of the organizations at Level C. “True north,” Berwick writes, lies at Level A: patients and their experiences.

From the Introduction:

"In this paper I present a “user’s manual” for this long, often dense report, with the goal of making its challenges less daunting."

The user's manual is available in pdf format at:
http://www.healthaffairs.org/freecontent/v21n3/s11.htm

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