Page 147 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch10_131-156.qxd 11/6/09 5:59 PM Page 134
134 unit 2 | Working Within the Organization CikguOnline
box 10-1 upon which the 21st-century health-care system is
being built.
Institute of Medicine Priority Areas
(IOM, 2003b). To Err is Human—discussed later in this chapter—
quantified unnecessary death in the U.S. health-
• Asthma • Ischemic heart disease
• Cancer screening • Major depression care system and placed emphasis on system failures
• Care coordination • Nosocomial infections as the foundation for errors and mistakes.
• Children with special • Obesity According the report, it is the flawed systems in
care needs • Pain control in advanced patient care that often leave the door open for
• Diabetes cancer
• End-of-life issues • Pregnancy and childbirth human error.The report made a series of eight rec-
• Frail elderly • Self-management ommendations in four areas (Box 10-3) that aimed
• Health literacy • Severe, persistent mental illness to decreased errors by at least 50% over 5 years.The
• Hypertension • Stroke goal of the recommendations was “for the external
• Immunizations • Tobacco dependence in adults
environment to create sufficient pressure to make
errors costly to health-care organizations and
providers, so they are compelled to take action to
The IOM and the Committee on the improve safety”(IOM, 2000, p. 4).The recommen-
Quality of Health Care in America dations sparked pubic interest in health-care quality
The IOM is a private, nonprofit organization char- and safety and caused prompt responses by the
tered in 1970 by the U.S government. The IOM’s government and national quality organizations.
role is to provide unbiased, expert health and scien- Crossing the Quality Chasm addressed broad quality
tific advice for the purpose of improving health. issues in the U.S.health-care system.The report indi-
The result of the IOM’s work supports government cated that the health-care system is fundamentally
policy making, the health-care system, health-care flawed with “gaps,” and it proposed a system-wide
professionals, and consumers.
In 1998 the IOM National Roundtable on
Health Care Quality released Statement on Quality box 10-2
of Care (Donaldson, 1998), which urged health-care IOM Quality Reports (IOM, 2006)
leaders to make urgent changes in the U.S. health- • Crossing the Quality Chasm: The IOM Quality Health Care
care system. The Roundtable reached consensus in Initiative (1996)
four areas regarding the U.S. health-care system: • To Err Is Human: Building a Safer Health System (2000)
• Crossing the Quality Chasm: A New Health System for the
1. Quality can be defined and measured; 21st Century (2001)
2. Quality problems are serious and extensive; • Envisioning the National Health Care Quality Report (2001)
3. Current approaches to QI are inadequate; and • Priority Areas for National Action: Transforming Health Care
Quality (2003b)
4. There is an urgent need for rapid change.
• Leadership by Example: Governmental Roles (2003)
This IOM statement launched today’s move- • Health Professions Education: A Bridge to Quality (2003a)
• Patient Safety: Achieving a New Standard of Care (2003)
ment to improve quality and safety for the 21st
• Keeping Patients Safe: Transforming the Work Environment
century U.S. health-care system. for Nurses (2004)
In 1998 the IOM charged the Committee on • Academic Health Centers: Leading Change in the 21st
the Quality of Health Care in America to develop Century (2004)
a strategy to improve health-care quality in the • Preventing Medication Errors: Quality Chasm Series (2006)
coming decade (IOM, 2000). The Committee
completed a systematic review and critique of liter-
ature that highlighted and quantified severe short- box 10-3
comings in the heath-care system. Its work led to Focus Areas of To Err is Human
the series of reports that serves as the foundation Recommendations (IOM, 2000)
and strategy for health system reform (Box 10-2). • Enhance knowledge and leadership regarding safety.
Two in particular, To Err is Human: Building a • Identify and learn from errors.
Safer Health System (IOM, 2000) and Crossing • Set performance standards and expectations for safety.
the Quality Chasm: A New Health System for the • Implement safety systems within health-care organ-
izations.
21st Century (IOM, 2001), provide a framework