http://bmj.com/cgi/content/full/323/7322/1192

 

BMJ 2001;323:1192 ( 17 November )

Reviews

Book

Crossing the Quality Chasm: A New Health System for the 21st Century

Institute of Medicine

National Academy Press, $44.95, pp 364 

ISBN 0 309 07280 8

See www.nap.edu for ordering details

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Rating: star star star star

Even with catchy titles, committee reports are unlikely bestsellers. This one has the background and intention to be different. The committee members, who were appointed by the US National Academy of Science for their creative thinking and knowledge of medicine, healthcare, and commerce, provide excellently researched evidence for the failure of the US healthcare system. They justify radical change and establish six aims and 10 simple rules for a completely different healthcare system. They call for a common purpose and as few simple rules as possible, based on a complex adaptive system model, and they contrast this with the current bureaucratic attempts to regulate problems created by the system itself.

The report explores the development of information technology, arguing that human brains should be reserved for judgments that are too complex for computers rather than for feats of memory. Brief case descriptions develop a powerful vision of what it might be like to experience this new healthcare. Although the authors don't go into the detail that would in reality have to be developed between those providing and receiving care, the vision is strong and convincing.

There are two major obstacles to the vision, and the book addresses both of these. The first is cost; the second---professionals' attachment to their current culture, roles, and professional identity---is probably harder to overcome. The authors argue that the present system is so wasteful that a new system could not fail to be more economic. Costs---including compensation for medical errors---are out of control. On all counts, the system is failing and there is no choice but change.

This report will influence healthcare policy makers throughout the world for at least the next 10 years. The NHS could be a more receptive environment for the vision than the US healthcare system. Even the section on funding applies to the United Kingdom. Already, government pronouncements on the NHS, on change, and on quality, and much of the work of healthcare think tank the King's Fund reflect the vision outlined in this report.

But will this be a bestseller? It deserves to be. It is relatively easy to read and is mandatory for anyone who has any interest in the future of healthcare or who wishes to understand the direction of current developments for quality, such as clinical governance. It also serves as a handbook for personal development and reflective practice. I suggest that the willingness of the workforce to embrace its ideas is crucial to the survival of the UK health service, so sales of this book could be a prognostic indicator for the NHS. Buy it and read it.

Alastair Baker, consultant paediatric hepatologist. 

King's College Hospital, London

© BMJ 2001

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.