Improving Health Care Quality: Current Concepts

According to the 1999 Institute of Medicine To Err is Human report, poor quality health care extracts a terrible toll, taking up to 100,000 American lives annually, more than breast cancer, motor vehicular accidents and AIDS combined.1 At the same time, another 770,000 people are injured in hospitals. Beyond the personal losses, society pays an enormous price, estimated to be between $37–50 billion a year, in damages and lost productivity. Perhaps because of the Institute of Medicine (IOM) report, or health care's ever-growing financial drain, or dismay about poor access, or fears of malpractice, or just some unexplained tipping point, public disquietude surrounding medical errors has never been greater. And for many of the same reasons, never have more professionals—providers, policy analysts, engineers, economists, executives, academics—poured more time or more energy into crafting solutions. These strategies can be divided into five broad categories: cooperation, industrial engineering, validation and certification, exhortation and compensation; each has its own history, case studies, merits and pitfalls.