The implementation of quality and safety measures: from rhetoric to reality

The evolution of American healthcare is the history of recurrent attempts to enhance quality of care. The latest wave of debate in this area was sparked by the 1999 Institute of Medicine Report, To Err is Human. In the current debate over how best to improve safety and quality, however, there has been a disconnect between the theoretical optimum and the practical possibilities. The author examines the history of our nation's efforts at healthcare improvement over the years, and concludes that the present debate will likely lead to improvements--but only after a messy (and necessary) political struggle over what price Americans are willing to pay for improvement, and where that money will come from. When reform occurs, the author believes that it will be on multiple levels, with accreditation organizations and various levels of government acting in the manner (and for the constituencies) appropriate to each. Ultimately, the political processes will yield a variety of approaches to be watched, studied, and amended as the healthcare system evolves to provide safer, more effective care.