Breaking Through the Denial about Health Care Quality in the United States

That Americans get only half of recommended care is not an easy message to deliver - or to receive: A strong communications effort by RAND researchers helped change conventional wisdom and spur new policies to improve quality

Field of Work: Health care quality research

Problem Synopsis: A large community-based study conducted by the RAND Corporation found that adults were receiving on average 55 percent of recommended care. Children fared even worse, getting 47 percent of recommended care. Where patients lived didn't affect the outcomes very much—and neither did their age, gender, race, income, education, or whether or not they had insurance.

"The things we found had been found for decades," said Elizabeth McGlynn, PhD, who directed the research team and now heads the Kaiser Permanente Center for Effectiveness and Safety Research. A strong dissemination effort was clearly needed to "break through the denial about how good quality is in this country."

Synopsis of the Work: Working with Washington-area-based Burness Communications, the RAND team published four articles in sequence focusing on discrete "messages" from their findings. The findings about the poor state of health care quality drew strong media coverage and intense scrutiny by researchers and policy-makers. Burness staff prepared the RAND researchers to respond to media questions and promote their messages.


  • The communications effort around the RAND study has helped to change conventional wisdom about the quality of care and to mobilize policy-makers, according to McGlynn. "The huge impact of the study was to get peoples' attention that there was a problem and we needed to be vigilant in measuring how well we were doing and to invest in finding ways to then close the gaps."