The committee's 19-member roster included prominent healthcare policy experts, including Dr. Donald Berwick, founder and then-president of the Institute for Healthcare Improvement, who now serves as CMS administrator; Lucian Leape, adjunct professor at the Harvard School of Public Health and chairman of the Lucian Leape Institute; and Mary Wakefield, current administrator of HHS' Health Resources and Services Administration.
Members laid out an agenda that featured six aims for healthcare—that it should be safe, effective, patient-centered, timely, efficient and equitable—as well as detailed lists of rules and recommendations to be used to redesign care. For instance, the committee recommended aligning payment policies to spur quality improvement, a practice that has been attempted in small-scale pilots and private-payer initiatives and is now being rolled out on a larger scale by the CMS.
Those strategies, according to Janet Corrigan, president and CEO of the National Quality Forum, are what differentiated the Crossing the Quality Chasm report from the committee's earlier report on safety.
“To Err is Human was a wake-up call and it had a huge communications impact,” says Corrigan, who served as director of IOM's healthcare quality project staff, which oversaw production of the two reports. “But Crossing the Quality Chasm was more of a road map for fundamental change of the system. Indeed, for us to address the problems in the original report, we needed to go down that road.”
Corrigan echoes Chassin's view that the quality report helped to change the mindset of those in the healthcare system and put performance improvement high on the priority list. That shift, she says, has paved the way for improvements, including the development of quality measures and increasing adoption of health information technology, bolstered by the healthcare IT provisions of the federal stimulus law.
Other steps in the right direction have included the launch of Hospital Compare, the CMS' quality information website for consumers, and hospitals' use of process-improvement tools such as Lean and Six Sigma, says Dr. Robert Wachter, professor and chief of the division of hospital medicine at the University of California at San Francisco.
And with last year's passage of the Patient Protection and Affordable Care Act, many of those early efforts will be rolled out on a much larger scale, says Wachter, who has written extensively on quality improvement and patient safety.
“To have accomplished that much in a decade is fairly impressive,” Wachter says. “If you had asked me how quickly we would evolve, I would not have guessed we'd have done as much as we have.”
One of the largest drivers of system improvement in the healthcare reform law will likely be the Center for Medicare and Medicaid Innovation, the committee members say. The center, which began operations in January, will test new models of care that have the potential to curb costs and enhance quality. The center is important because it addresses the question of how to improve quality while allowing for differences across communities and delivery systems, Chassin says.
“Setting up payment incentives and targets is important, but the biggest challenge for healthcare organizations is figuring out how to reach those goals we are all aiming for,” Chassin says. He also points to the Joint Commission's Targeted Solutions Tool, a Web-based resource that offers tested improvement tips and strategies to all accredited hospitals. Chassin says the site has attracted more than 25,000 visitors since it went live five months ago.
The Affordable Care Act will also address healthcare inequality, one of the central aims of the report, says Arthur Levin, who served as a member of the committee and is director of the not-for-profit Center for Medical Consumers.