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The health care report To Err Is Human, confronted health care clinicians and managers with concerns about the poor quality of health care attributable to misuse, overuse, and underuse of resources and procedures, which was responsible for thousands of deaths (IOM, 1999). The health care report, Crossing the Quality Chasm (IOM, 2001), and several large studies (McGlynn et al., 2003; Thomas et al., 2000), have shown that the quality of health care in the United States is at an unexpected low level and needs improvement in many dimensions, given the amount of money the United States spends on health care (Table 2.7). One implication is that if a measure is described in a way that is clear and understandable, people are more likely to value the measure (AHRQ, 2011).

Table 2.7 Health Care Dimensions Needing Improvement

Health Care Should Be	Health Care Should
1. Safe: Avoid injuries from care intended to help patients.	1. Offer care based on continuous healing relationships: Make care available every day through face‐to‐face visits, telephone, Internet, and other means.
2. Effective: Provide services based on scientific knowledge to all who could benefit, and refrain from providing services to those not likely to benefit (avoid overuse and underuse).	2. Customize care based on patient needs and values: Provide care responsive to patient needs and preferences.
3. Patient centered: Provide respectful and responsive care to individuals; patient preferences, needs, and values must guide clinical decision making.	3. Have the patient as source of control: Foster patient empowerment and autonomy through information and shared decision making.
4. Timely: Reduce wait time and harmful delays for those who receive and give care.	4. Share knowledge and free flow of information: Facilitate patient access to his or her own medical information and to available clinical knowledge.
5. Efficient: Avoid waste, for example, of equipment, supplies, ideas, energy, and other costly resources.	5. Use evidence‐based decision making: Provide consistent quality of care based on best available scientific knowledge.
6. Equitable: Provide care consistent in quality irrespective of gender, ethnicity, geographical, and socioeconomic factors.	6. Develop safety as a systems property: Develop systems of safety that mitigate error, promote patient safety, and reduce risk of injury.
	7. Be transparent: Make information available to patients and families about health plans, hospitals, clinical practice, and alternative treatment options, including performance related to their safety, evidence‐based practice, and patient satisfaction.
	8. Anticipate needs: Anticipate patient needs rather than respond to events.
	9. Continuously decrease waste: Use limited resources wisely.
	10. Cooperate among clinicians: Collaborate and coordinate care between clinicians and institutions.

Source: Compiled with information from the Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press; and Berwick, D. M. (2002). A user's manual for the IOM's ‘Quality Chasm’ report. Health Affairs, 2 (3), 80–90.