After “To Err Is Human” (2000); The Institute of Medicine (IOM) published another influential book “Crossing the Quality Chasm“ (2002),  This book called attention to three broad categories of quality defects:

Underuse:

Whereby scientifically practices are not used as often as they should be;

Overuse:

Especially of imaging procedures and prescription of antibiotics; and

Misuse:

When a proper procedure is not administered correctly (e.g. prescribing the wrong medication)

The IOM outlined six specific aims (explained by Dr. Donald Berwick in the video below) that a health care system must fulfill to deliver quality care:

1. 1. Safe: Care should be as safe for patients in healthcare facilities as in their homes;
   2. Effective: The science and evidence behind health care should be applied and serve as the standard for the delivery of care;
   3. Efficient: Care and service should be cost-effective, and waste should be removed from the system;
   4. Timely: Patients should experience no waits or delays in receiving care and service;
   5. Patient-centered: The system of care should revolve around the patient, respect patient preferences, and put the patient in control;
   6. Equitable: Unequal treatment should be a fact of the past; disparities in care should be eradicated.

Recognizing that aims must be accompanied by observable metrics, the IOM defined sets of measurements for each aim. For example:

• • Safe: Overall mortality rates or the percentage of patients receiving safe care;
  • Effective: How well evidenced-based practices are followed, such as the percentage of times diabetic patients receive all recommended care at each visit;
  • Efficient: Analysis of the costs of care by patient, provider, organization, and community;
  • Timely: Waits and delays in receiving care, service, or results;
  • Patient-centered: Patient and family satisfaction;
  • Equitable: Differences in quality measures by race, gender, income, and other population-based demographic and socioeconomic factors.

Source:

The Healthcare Quality Book (2nd edition), edited by Elizabeth R. Ransom, Maulik S. Joshi, David B. Nash, and Scott B. Ransom.