Inside the IOM: Advancing a Culture of Health in America

    • December 12, 2013

In the first moments after a patient is admitted to a hospital, nurses, physicians, and staff engage in a well-choreographed ballet of checks and balances to prevent infections and potentially life-threatening mistakes.

Many of the safety procedures were put in place after the publication of To Err is Human, the 1999 Institute of Medicine (IOM) report that alerted the nation to the fact that as many as 98,000 lives were lost to medical errors each year. Like many IOM reports, the document led to innovative regulations and an acute awareness of the need for change.

Guided in part by the work of at least 15 Robert Wood Johnson Foundation (RWJF) Human Capital grantees who have become members in recent years, the IOM is known among medical experts and policy-makers for its powerful influence on research, policy, and standards of care, though it is virtually invisible to most of the general public.

To Err is Human is still one of the top 10 downloads on our site,” says Clyde Behney, the interim Leonard D. Schaeffer executive officer at the IOM.

The report stands alongside Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002) and The Future of Nursing: Leading Change, Advancing Health (2010) as seminal documents in the effort to understand the health needs of all Americans and identify the best way to meet those needs.

Unequal Treatment established the sources and extent of disparities in care, and provided comprehensive recommendations for solutions and research to solve the problem.  

The Future of Nursing offered a blueprint for transforming the nursing profession to improve health and health care so that everyone in America can live a healthier life, supported by a system in which nurses are essential partners in providing care and promoting health. The report was made possible by support from RWJF.

The Voice of Reason

Founded in 1970 by the National Academy of Sciences, the IOM is not a branch of government, though it has generated many changes in legislation. With the exception of a small epidemiology unit, it does not conduct medical research. Yet its findings often establish best practices for medical care.

“What we do is help to define problems, clarify questions and give direction on the ways that people need to come together around a particular issue. We are very rigorous about avoiding conflicts of interest, politics, and biased opinions,” Behney says. “This is especially important at a time when there are so many voices advising our political and public process.”

When the IOM contracts to study an issue—often at the suggestion of a foundation, legislator, or federal agency—the first step is gathering input. “We have public hearings, hold workshops, select study directors from our staff, and conduct background research to inform the interdisciplinary team of committee members who will work along with staff to produce a report,” Behney says. The information considered for IOM reports comes from existing research, stakeholders, and interdisciplinary teams of experts around the world.

This process is unlike any other in the field of health policy, because, Behney explains, “While we were created, in part, to advise Congress and federal agencies, we are exempt from the Federal Advisory Committee Act. That means the deliberative portion of our work is confidential. No federal government official can control our agenda, see documents in draft form, edit reports, or participate in report committees in any way. We deliberate in closed, confidential sessions. Committee reports are only to be informed by the evidence. The results cannot be quashed and reports are released directly to the public.”

Members: A Lifetime Commitment to America’s Health

At the center of the IOM report process and roundtables are the organization’s members—one of the most carefully selected and vetted groups of social scientists, physicians, nurses, economists, epidemiologists, and legal experts in the world. “Our members are selected based on their accumulated achievements across their career,” Behney explains. “They are also selected by their peers, as the current membership votes on new members. Being chosen is an instant message that you have joined a very small, very exclusive group and been recognized by your colleagues.”

This year, 70 new members were elected to the IOM, including seven RWJF Human Capital grantees: RWJF Clinical Scholars alumni Christopher J. Elias, MD, MPH, and Tracy A. Lieu, MD, MPH; RWJF Investigator Awards in Health Policy Research recipients Sandro Galea, MD, DrPH, Jens Ludwig, PhD, Jack Needleman, PhD, FAAN, and Sara Rosenbaum, JD; and RWJF Scholars in Health Policy Research alumna Paula M. Lantz, PhD.

Thomas A. LaVeist, PhD, a National Advisory Committee member, RWJF Health & Society Scholars, and  Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing, were also elected this year.

For the rest of their professional lives, they will work on committees that will take on some of the most challenging health care issues of our time. “With election comes an expectation that each member will serve the IOM by working on report committees or other activities that are appropriate to their expertise,” Behney says.

Coming in 2014

“We are very proud of our balanced, unbiased approach to exploring issues,” Behney says. “We are often seen as conservative, in a non-advocacy sense, because we do not take sides, but we feel that our work can be taken more seriously because it comes from an objective process.” The IOM’s role as the “Switzerland” of health issue debates will no doubt be important when the agency releases its next report. “We are exploring whether we can change the way graduate medical education is funded,” Behney says, “to see if it can be done in a more effective way.”


Related websites

Learn more about the RWJF Clinical Scholars program.
Learn more about the RWJF Health & Society Scholars program.
Learn more about the RWJF Investigator Awards in Health Policy Research program.
Learn more about the RWJF Scholars in Health Policy Research program.
For an overview of RWJF scholar and fellow opportunities, visit

Six Facts About the IOM

Six Facts About the IOM

  • Only 2,000 people have been honored with membership in the IOM since it was established in 1970.
  • Once you are a member, you remain a member for the rest of your life.
  • Members of study committees are not paid. They are volunteers.
  • The IOM is not a government agency. It is the not-for-profit health arm of the National Academy of Sciences.
  • No one outside of a report committee can control the contents of an IOM report.
  • The report that has received the most public comment in the IOM’s history is not about human health; it is Chimpanzees in Biomedical and Behavioral Research (2011).