The Current State of Health Care Quality

Despite advances in medical technology and research in recent years, health care in America has evolved into a vast, fragmented industry, beset with huge problems of access and quality. Millions of Americans still lack health insurance—and for those that can get care, paid for by their employer or through other means, the quality of care is not what it should be. In the seminal 2001 report Crossing the Quality Chasm, the Institute of Medicine (IOM) describes this quality crisis as having three main dimensions: “underuse,” “overuse” and “misuse” of care.

To improve quality, the IOM recommended the following three principles: It said improvements should focus on making sure that care is “knowledge-based,” “patient-centered” and “systems-minded.”

Many health care leaders and professionals have tested incremental and technical approaches to improving health care, similar to system redesign initiatives that have taken hold in large corporations. These approaches have yielded case studies and examples of how individual institutions and specific health care systems around the country have improved care.

To go beyond these individual examples, the Robert Wood Johnson Foundation is investing in targeted regions across the country and working with multiple stakeholders in these areas to improve health care across the spectrum. This regional strategy, called Aligning Forces for Quality, enlists doctors, nurses, hospitals, patients, consumer groups, employers, health plans and other health professionals to work together to improve quality in ways that transform health care for patients from all racial and ethnic backgrounds. The central goals of Aligning Forces are:

  • To help providers improve their own ability to deliver quality care.
  • To help providers measure and publicly report their performance, as a fundamental means to understand where quality gaps are occurring.
  • To help the major forces that influence health care in any one place—such as businesses, health plans, doctors, nurses, and patients—align around some fundamental goals for change.
  • To help patients and consumers understand their vital role in recognizing and demanding quality health care.