Note |
The
IOM asserts improvement requires care that is:
-
knowledge-based
-
patient-centered
- symptoms-minded |
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Determining
Needs and Setting Priorities for Systems Change
IOM
Recommendations for Practice Redesign
Clinical
practices can be viewed as microsystems that produce services for
specific patient populations.1
2
3
The
Institute of Medicine's Quality Chasm report asserts that
achieving improvement will require redesigns of these small units
of work and suggests three comprehensive redesign principles:
that care should be knowledge-based, patient-centered, and systems-minded.4
Self-assessment of a clinical practice could be based on achievement
of these principles for redesign.
The
report proposes ten new, simple rules as a framework for the enhancement
of the effectiveness of health care microsystems. Below each new
rule is listed the prevailing and less helpful, current design rule.3
See
toolbox below to print out this chart in Adobe Acrobat format.
New
Rule |
Current
Rule |
1 |
Care
is based on continuous healing relationships. |
Care
is based primarily on visits. |
2 |
Care
is customized according to patients needs and values. |
Professional
autonomy drives variability. |
3 |
The
patient is the source of control. |
Professionals
control care. |
4 |
Knowledge
is shared freely. |
Information
is a record. |
5 |
Decision-making
is based on evidence. |
Decision-making
is based on training and experience. |
6 |
Safety
is a system property. |
"Do
no harm" is an individual responsibility. |
7 |
Transparency
is necessary. |
Secrecy
is necessary |
8 |
Needs
are anticipated. |
The
system reacts to needs. |
9 |
Waste
is continuously decreased. |
Cost reduction is sought. |
10 |
Cooperation
among clinicians is a priority. |
Preference
is given to professional roles over the system. |
Tool
Download |
New
Rules Guideline
Description:
Print out your own copy of the new rules to
use as a framework to improve the effectiveness
of your system.
Click
to download
File
Format |
.pdf |
File
Size |
56k |
Download
Time: 56k modem |
<1
minute |
Download
Time: cable or dsl |
<10
seconds |
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IOM
Recommendations for Organization Redesign
The
organizations (hospitals, multispecialty group practices, integrated
delivery systems) that house microsystems need to provide the tools
and the support necessary for the work conducted in the microsystems.
The IOM Quality Chasm report identifies major gaps in the
quality of today's health care organizations. The report recommends
that health care organizations need better designs in at least six
areas, if microsystems are to succeed. Self-assessment of health
care organizations could be based on achievement of redesign in
these areas.
- Better
systems for finding best practices and assuring that these best-known
clinical models
become organizational standards.
-
Better use of information technology to improve access to information
and to support clinical decision-making.
-
Improved workforce knowledge and skills.
- More
consistent development of effective teams and teamwork.
-
Better coordination of care among services and settings, both
within and among organizations, especially with respect to the
care of people with chronic illnesses.
-
More sophisticated, extensive, and informative measurement of
performance and outcomes.
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