ABSTRACT
In 2000 and 2001, the US Institute of Medicine published two reports that set a new tone in the ongoing calls for health care reform. In the first report, ‘To Err is Human: Building a Safer Health System’ (Kohn et al. 2000), the Committee on Quality of Health Care in America claimed that medical errors (such as administering wrong drugs, or failing to execute a planned intervention) are a leading cause of death in the United States. Critique was raised against the precise figures listed, and the exact definitions of ‘error’, yet the overall argument of the report was not substantially contested. The US health care environment was not the ‘safe environment’ that one would expect it to be. One year later, the same committee published Crossing the Quality Chasm: A New Health System for the 21st Century, in which the insights of the first report were generalized to the claim that the overall quality of US health care services was far below standard. Given the amount of resources spent and the motivation of the average health care professional, the Committee argued, there is a huge chasm between what the overall quality delivered by the system should be and what it actually is. The Committee discerned six dimensions of ‘quality’:
1 Safety (‘patients should not be harmed by the care that is intended to help them’).
