Health Information Management: Integrating Information Technology ...

80 MEETING THE CHALLENGE
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Standardized care path
Redistribution of workactivities
Flexible standardization
Care process redesign
INTRODUCTION
In 2000 and 2001, the US Institute of Medicine published two reports that set a
new tone in the ongoing calls for health care reform. In the first report, ‘To Err is
Human: Building a Safer Health System’ (Kohn et al. 2000), the Committee on
Quality of Health Care in America claimed that medical errors (such as
administering wrong drugs, or failing to execute a planned intervention) are a
leading cause of death in the United States. Critique was raised against the
precise figures listed, and the exact definitions of ‘error’, yet the overall argument
of the report was not substantially contested. The US health care environment
was not the ‘safe environment’ that one would expect it to be. One year later, the
same committee published Crossing the Quality Chasm: A New Health System
for the 21st Century, in which the insights of the first report were generalized to
the claim that the overall quality of US health care services was far below
standard. Given the amount of resources spent and the motivation of the average
health care professional, the Committee argued, there is a huge chasm between
what the overall quality delivered by the system should be and what it actually
is. The Committee discerned six dimensions of ‘quality’:
1 Safety (‘patients should not be harmed by the care that is intended to help
them’).
2 Effectiveness (the care given should be evidence-based, and optimally
directed at the individual’s medical needs; practice variations should be due
to differences between patient situations, not to individual preferences of
professionals).
3 Patient centred (care should respect patients’ values, preferences and
expressed needs; patients can and should be much more involved in the
planning, organization and delivery of their own care; services should be
organized and integrated around the patients’ experience, to maximize
physical and emotional comfort; information, communication and education
should be central).
4 Timeliness (waiting times and delays before and during care delivery should
be minimized. ‘Any high-quality process should flow smoothly.’).
5 Efficiency (care should be directed at getting ‘the best value for the money
spent’. Waste through inefficient processes, inefficient utilization of
resources or the execution of non-effective interventions should be
reduced.).
6 Equity (health care should be universally accessible, and the quality of care
received should not depend on individuals’ personal characteristics such as