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What’s Different About Now, Compared to 1999? A Whole Lot

September 10, 2012
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The Institute of Medicine’s new comprehensive report urges the healthcare industry to become one in which continuous learning and performance improvement are the norm


I remember very well the release of the Institute of Medicine’s groundbreaking report, “To Err Is Human,” in November 1999. That report not only received a huge amount of attention within the healthcare industry; it also had the unprecedented result of piercing the usual shroud around intra-healthcare industry developments, and reaching into the mainstream media.  Primarily, this was because of the insertion of a key statistic: the study finding that between 44,000 and 98,000 patients were dying in hospitals every year from fully preventable medical errors. Not surprisingly, that finding caught people’s attention, and made even the broader public aware for the first time of the patient safety gap in healthcare—at least in hospitals.

Part of the impact of that report had to do with the realization across healthcare that the industry was basically completely unprepared at that time to enact the kinds of systemic changes that the authors of “To Err Is Human” were calling for. In contrast, the release last week of the IOM’s third comprehensive report (in 2001, the IOM had followed up with a second report, “Crossing the Quality Chasm”), "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America," which calls for a very concerted range of efforts, and the transformation into a continuous learning system industry-wide, has been released in an industry that has already taken some of the concepts of “To Err Is Human” (as well as “Crossing the Quality Chasm”) to heart.

Indeed, some of the best-known pioneer hospitals, medical groups and health systems in the United States are already doing what the authors of “Best Care at Lower Cost”—a committee of industry luminaries—are urging everyone to do. That is, they have created cultures of continuous learning and performance improvement, have learned how to coordinate care across the care continuum, have built bridges to their communities, and have created the core clinical and other IT infrastructures needed to support continuous performance improvement and learning.

Now, is healthcare as an industry still very, very early along the path to industry-wide continuous learning and performance improvement? Absolutely; that’s undeniable. At the same time, there already exists a basis for the kind of concerted work the IOM leaders are calling for in “Best Care,” and what’s more, at least the beginnings of operational and care delivery models exist now for hospitals, medical groups, and health systems to follow, as they emulate the pioneers in the field.

So 2012 really is different from 1999. And while the full realization of the concepts embedded in this latest IOM report will take literally decades to fully achieve, some of the core of the architecture that will be required to create continuous learning and performance improvement in healthcare has begun to be put in place. What’s more, CIOs, CMIOs, and other healthcare IT leaders will be critical leaders within their own organizations and across the industry in making all this happen. Will it be easy? Of course not. Is the vision of a continuously learning and improving healthcare system possible? To be frank, this is something that must ultimately be achieved, in order to make our healthcare system sustainable over the long term. So the question really is, how readily will healthcare leaders move forward to adopt the IOM’s vision of what the healthcare system can and should be? That question is an open one; but it’s one whose answer we’ll be learning in the next few years, which are set to be years full of forward-moving evolution and change. Stay tuned—it should be a fascinating, if inevitably bumpy, ride.