![]() As Ken Shine, former president of the Institute of Medicine (IOM), attested at the summit: And even though the hospital sector has been consolidating in many markets-of the 5,000 community hospitals, more than 3,500 belong to some network or system-most of these arrangements are focused on administrative rather than clinical integration (American Hospital Association, 2000 Lesser and Ginsburg, 2000). The health plan sector is turning away from structures that can facilitate integration and coordination, with the market share of health maintenance organizations (HMOs) falling and preferred provider organizations (PPOs) becoming more popular (Kaiser Family Foundation and Health Research and Educational Trust, 2002). Although the size of physician groups is growing, 37 percent of practicing physicians are still in solo or two-person practices (Center for Studying Health System Change, 2002). Rather it is a dizzying array of highly decentralized sectors. The health care system can hardly be called a system. These reasons include (1) poor design of systems and processes, (2) the system’s inability to respond to changing patient demographics and related requirements, (3) a failure to assimilate the rapidly growing and increasingly complex science and technology base, (4) slow adoption of information technology innovations needed to provide care, (5) little accommodation of patients’ diverse demands and needs, and (6) personnel shortages and poor working conditions. The committee that authored the Quality Chasm report (Institute of Medicine, 2001), speakers at the summit, health experts, employers, and health professionals and students have all identified reasons for this disconnect between an ideal system and what actually exists. A survey of over 800 physicians found that 35 percent of them reported errors in their own or a family member’s care (Blendon et al., 2002). physicians surveyed said their ability to provide quality care has been reduced in the last 5 years, and 41 percent stated that they are discouraged from reporting or not encouraged to report medical errors (Blendon et al., 2001) 76 percent of nurses surveyed indicated that unsafe working conditions interfere with their ability to deliver quality care ( American Nurses Association/NursingWorld.Org, 2001). Health professionals are also concerned: 57 percent of U.S. The American public is dissatisfied with chronic care 72 percent of those surveyed believe it is difficult for people living with chronic conditions to obtain the necessary care from their health care providers (Harris Interactive and ARiA Marketing, 2000). Estimates of the number of Americans dying each year as a result of medical errors are as high as 98,000-more than those who die from motor vehicle accidents, breast cancer, or AIDS (Institute of Medicine, 2000). Likewise, the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998: 21) note that “today, in America, there is no guarantee that any individual will receive high-quality care for any particular health problem.” Numerous recent studies have led to the conclusion that “the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering” (Chassin et al., 1998:1005). The current quality crisis in America’s heath care is well recognized. ![]()
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