Hidden Barriers to Improvement in the Quality of Care

Abstract

The public has just begun to recognize that despite the enormous achievements of American medicine and the American health care system, the quality of care in this country needs to be and can be improved. Two recent reports from the Institute of Medicine dramatized the need for greater attention not only to potential problems with quality but also to the entire structure of the delivery system.^1,2 The reports also proposed many approaches to improving quality, based to a great extent on the paradigm of the overuse, misuse, and underuse of medical technology (drugs, devices, and procedures).³ Reducing errors has become a key component of these approaches, and considerable resources for research and demonstration activities to reduce errors have recently been made available throughout the health care system.