INSTITUTE OF MEDICINE REPORT - CROSSING THE QUALITY
[Creating a Patient-Centered Health Care System]
Ten Rules for Redesign
"To help in achieving these improvement aims, the committee deemed that it would be neither useful nor possible to specify a blueprint for 21st-century health care delivery systems. Imagination abounds at all levels, and all promising routes for innovation should be encouraged.
At the same time, the committee formulated a set of
ten simple rules, or general principles, to inform efforts to redesign the health system. These rules are:
1. Care is based on
continuous healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.
2. Care is customized according to patient needs and values. The system should be designed to meet the most common types of needs, but should have the capability to respond to individual patient choices and preferences.
3. The patient is the source of control. Patients should be given the necessary information and opportunity to exercise the degree of control they choose over health care decisions that affect them. The system should be able to accommodate differences in patient preferences and encourage shared decision making.
4. Knowledge is shared and information flows
freely. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
5. Decision making is evidence-based. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.
6. Safety is a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.
7. Transparency is necessary. The system should make available to patients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the systemís performance on safety, evidence-based practice, and patient satisfaction.
8. Needs are anticipated. The system should anticipate patient needs, rather than simply react to events.
9. Waste is continuously decreased. The system should not waste re-sources or patient time.
10. Cooperation among clinicians is a priority. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care."
Full text: http://www.iom.edu/focuson.asp?id=8089