The fact that this issue of the Bulletin is focused on information technology in practice management demands a review of the Institute of Medicine’s new book
Crossing The Quality Chasm: A New Health System for the 21st Century; a review of this book demands the balance of also considering J.D. Kleinke’s new work entitled Oxymorons: The Myth of a U.S. Health Care System. So let me tell you about both.
Ten Simple Rules
The Institute of Medicine appointed the Committee on Quality of Health Care in America in 1998 to identify strategies for achieving a substantial improvement in the quality of healthcare delivered to Americans. The committee’s first report, To Err Is Human: Building a Safer Health System, was released in 1999 and focused on patient safety. Crossing the Quality Chasm, the committee’s second and final report, focuses on designing a new system that will innovate and improve healthcare.
The report’s premise is that healthcare should be supported by systems that are carefully and consciously designed to produce care that is safe, effective, patient centered, timely, efficient and equitable. The authors came up with the new 10 commandments which they call 10 Simple Rules for the 21st Century Health Care System:
- RULE 1: Care is based on continuous healing relationships.
- Rule 2: Care is customized according to patient needs and values.
- RULE 3: The patient is the source of control.
- RULE 4: Knowledge is shared and information flows freely.
- RULE 5: Decision making is evidence-based.
- RULE 6: Safety is a system property.
- RULE 7: Transparency is necessary.
- RULE 8: Needs are anticipated.
- RULE 9: Waste is continuously decreased.
- RULE 10: Cooperation among clinicians is a priority
The authors acknowledge that these changes will be enormously expensive, but that the changes are both possible and necessary. Taking advantage of new information technologies will be the key catalyst to moving us beyond where we are today. They have recommendations that will facilitate their plan for all healthcare organizations, providers, purchasers, Congress and federal agencies.
Everyone involved in healthcare must read this book. We do work in a flawed system and steps must be taken to improve healthcare in America.
Three Simple Facts
In Oxymorons J. D. Kleinke admits that he was wrong about managed care in his 1998 book, Bleeding Edge: The Business of Health Care in the New Century. He now acknowledges that managed care organizations were asked to do a job that they could not do. This book is based on three simple, intractable facts about the financing and delivery of healthcare. First, chaos is the rule in the delivery of healthcare. Second, behavioral inertia among the layers of healthcare administration wrapped around the actual delivery of medicine is the inevitable consequence of fact number one. And third, experts are prone to repeat the same mistakes, which he calls the Twaddle Echo Factor. Physician risk-contracting will not fix everything. Consumerism will not fix everything. “Leadership” will not fix everything. The Internet will not fix everything.
Kleinke is much more cynical than the Committee on The Quality of Health Care in America about fixing our system of healthcare. He has a wonderful chapter entitled “The Chaos Theory and Medicine.”
I liked Kleinke’s book because he, too, presents a “simple” plan. His solution is not to introduce more bureaucracy but to introduce a simpler plan of taxation. He would have us throw out our system of employer-based health insurance and replace it with individually mandated and purchased insurance. He thinks that we can save 18 cents of every healthcare dollar by simplifying administration and then covering every citizen with a very basic benefit package.
It seems as thouugh most people agree that our present system is broken. We all need to be reading books such as these two so that we can become part of the solution rather than continuing to be part of the problem.
Gary Vander Ark, MD, is a senior partner of Rocky Mountain Neurosurgical Alliance, Englewood, Colo., and past president of the Colorado Medical Society. He is the recipient of the 2001 AANS Humanitarian Award.