The Institute of Medicine (IOM) is a
nonprofit organization that provides guidance to the Nation on issues related
to biomedical science, medicine, and health. Established in 1970, the IOM is
the health arm of the National Academy of Sciences, which was chartered under
President Abraham Lincoln in 1863 (National Academies Press, 2013). The Institute of Medicine’s
Health Care Quality Initiative was launched in 1996 as an ongoing effort
focused on assessing and improving the Nation’s quality of care. The initiative
was divided into three phases; the first phase outlined the inequality that
existed in health care, the second phase concentrated on how to close the gap
in health care delivery, the third is an ongoing phase which focuses on
continued efforts to achieve the mission of quality health care for all.
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IOM Dimensions (Bold)
The Institute of Medicine created
six specific aims to accomplish to ensure health care systems are providing
quality care. These aims for health care systems focus on safety, effective
service, patient-centered, timely, efficiency and equitability. These aims are
to be measured through observable metrics within the organizations; ensuring quality
care is delivered to all patients. Frameworks like the IOM dimensions allow
patients to understand the meaning and importance of quality measures.
Safe: Avoiding harm to patients from the
care that is intended to help them. The science of safety includes tools used and methods to
improve current systems in place are currently practiced in the healthcare
industry. Changes in health care are commonplace and expected as scientific
discoveries are continually developing, challenging, implementing, and
evaluating improvement in clinical environments.
Effective: The science and
evidence behind health care should be based on scientific knowledge and applied
to serve all who could benefit from services provided. Health care tools created for use in health care settings work
on improving quality of care implemented, focusing on simplifying methods to
decrease amount of complexity involved in daily operations in the organization.
They should provide a simple method for accomplishing the goal of quality in
the delivery of care.
Patient-centered: Providing care that focused on
respecting the individual’s preferences and values while delivering care, to ensure
clinical decisions account for the patient’s needs in a respectful manner that
encourages their involvement in care (Schleyer, et al, 2012). When providers
commit themselves to communicating directly with patient and family regarding
diagnosis, prognosis and treatment plans they create an environment of trust.
This trust is then developed into long-term relationships of respect for
knowledge and health care that focuses on the patient as the most important
aspect to delivery of care, rather than treatment aspects. When the patient
feels he is an integral part of the health care experience, he will then become
an active member of implementing provider plan for treatment; increasing better
Timely: Reducing wait times and delays in
care to prevent and reduce negative health outcomes such as complications or
death. The IOM recommended that health care provide pain relief, attend to
physical symptoms, and needs promptly increasing patient emotional health and adjustment
to long-term care.
Efficient: Avoiding waste in health care includes
outdated equipment, overloading on supplies, and energy. The IOM stated that health care
should be coordinated and integrated and include timely transfer of up-to-date
patient information to health care professionals, and efficient transition of
patients between health care settings (Gamm, Kash, & Bolin, 2007). Providing follow-up as an intervention
to improve the coordination of care is being implemented in long-term care
strategies to improve outcomes after discharge or completion of treatments. Patients
given information that is easily understandable about all aspects of care including
support services are likely to recover faster, increasing patient satisfaction
and organization’s efficiency.
Equitable: Providing care that is equal in
quality of care delivered regardless of patient’s gender, ethnicity, geographic
location, and socioeconomic status. Low-income residents have been victim to inequality in care
for many generations, and are still at risk for losing access to care. This is
the most difficult of the six aims to implement, as it relies heavily on
constituent votes through legislative battles. Until it can be agreed that
access to health care should be considered a basic right to all, the equality
of care offered to people will vary based on funding and political powers.
Providing a framework for
understanding quality to patients helps them to expand on their health
knowledge and seek better quality of care with the use of quality indicators.
For example, when patients are given information of safe, effective, and
patient-centered care, they view all three categories as important (Fleischut, et al, 2011). When data
is compiled and interpreted for patients into user-friendly versions of those
three IOM domains, they are able to become active advocates for their care and
also able to engage in consumer demand for quality in care, creating change
within the health care organization for which they seek services. Developing a
relationship that is respectful and empathetic in combination with clinical quality
is crucial to achieving experiences which are registered as being exceptional (Lazar,