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20 HEC F. 1 (2008)

handle is hein.journals/hecforum20 and id is 1 raw text is: HEC Forum (2008) 20 (1): 1-14. DOI: 10.1007/s10730-008-9060-y © Springer 2008 The Institute of Medicine's Reports on Quality and Safety: Paradoxes and Tensions George Khushf - James Raymond - Charles Beaman, Jr. Introduction A significant transformation of American healthcare is currently underway, precipitated largely by a series of reports from the Institute of Medicine (IOM) on error and quality (Corrigan et al., 2000; Kohn et al., 2001). At the heart of this change is the claim that a new perspective is needed. Instead of focusing on problems of error and quality in traditional piecemeal fashion, what is needed is a systems approach that considers the interconnection of diverse problems and addresses them in an integrated manner. The IOM reports attempt to sketch what this would entail. Yet, in spite of that formulation, the IOM reports reveal certain paradoxes and tensions that become apparent upon close reading. One notable example is that while recognizing the deficiencies of a piecemeal view of quality, they still define error and quality in ways that are closely linked to it. They highlight published research reports and guidelines that are driven by the gold standard of clinical trials which assumes that the relevant causal factors can be isolated and discretely assessed. Thus, the reports both criticize and embrace fragmentation in their systems approach. This has ramifications that run deeper than just a superficial paradox. This essay explores some of these implications. Three areas in particular are briefly noted below by way of introduction. 1. Two opposing notions of management are contained within the IOM reports. The first is closely associated with a kind of human factors George Khushf, Ph.D., Humanities Director, Center for Bioethics, University of South Carolina, Columbia, S.C. 29208; email: Khushfg@gwm.sc.edu. James Raymond, M.D., M.S., Senior Vice President for Quality, Medical Education, and Research, Palmetto Health, Columbia, S.C. 29201; email: james.raymond@palmettohealth.org. Charles Beaman, Jr., M.H.A., President and CEO, Palmetto Health, Columbia, S.C. 29201; email: charles.beaman@palmettohealth.org.

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