The Institute of Medicine: Major Quality Issues


Committee reports may have attractive headlines that can capture readers’ interests. However, they do not feature among the best-selling publications. The Institute of Medicine (IOM) reports informing the healthcare sector on quality improvement and patient safety. They seek to identify the major issues facing providers, practitioners, beneficiaries, and regulators and propose workable solutions. Medical errors have escalated in recent years, increasing injury and death burdens to patients and their families. Some of the faults are understandable and easily preventable using the available knowledge and recommended practices (Institute of Medicine, 2000). It is common to blame practitioners for some errors, which is a misconception because some faults emerge from systemic issues. Healthcare providers are building safer systems to protect patients from accidental injury and promote quality care.

Complexities in value management indicate the need for collaboration among critical stakeholders. Prevention Quality Indicators (PPIs) and Patient Safety Indicators (PPIs) in a practice setting indicate the need for the organization to adopt the Institute of Medicine’s Reports’ recommendations. Executing the proposed measures can improve patient safety, control costs, and ensure quality improvement. Emphasis should be put on patient follow-up after discharge from the hospital and on improving casualty services. Building safety knowledge can be a practical solution to the problem because nurses and other primary care staff will have a sound understanding of the best practices for bedside clients. The U.S. Congress should set the research agenda and publish quality improvement reports addressed to the president to foster knowledge development. Adopting error-reporting systems, protecting voluntary reporting practices, and setting performance standards are the other formidable solutions.


  • The IOM supports U.S. care quality projects
  • Patient safety is a crucial component of quality
  • Medical errors cause injury and death
  • There are numerous causes of medical faults
  • IOM’s recommendations affect nurses’ care at the bedside

The IOM supports U.S. healthcare quality projects. The level of client security in a hospital or medical care center is a vital quality indicator (Institute of Medicine, 2000). Medical errors, some of which are unavoidable, remain a major cause of injury and death in the United States. There are numerous causes of welfare issues, some systemic and others tied to human factors. However, the recommendations provided by the IOM help nurses improve their care.

Systemic and Human Medical Error Factors

  • Systemic factors cause medical errors
  • Human factors also contribute to medical errors
  • A systems approach can address the problem
  • Patient safety implications should be considered
  • Collaboration and staff training address human factor problems

Existing studies indicate that a convergence of multiple factors contributes to medical errors, yet it is common to blame some healthcare professionals. Healthcare practitioners are some of the most educated and dedicated professionals (Institute of Medicine, 2001). Systems approach modifying the conditions leading to faults can prevent harm and enhance patient safety (Institute of Medicine, 2000). Human factor problems can be solved through the collaboration of the staff.

Prevention Quality Indicators (PQI)

  • PQIs address access to outpatient care problems
  • The selected practice setting faces patient follow-up challenges
  • Poor outpatient care has compromised care quality
  • Metrics identify healthcare quality issues
  • The data identify unmet community needs

PQIs address issues relating to access to outpatient care. The practice setting also has some problems concerning patient follow-up. The metrics can flag potential healthcare quality problems, assess the quality of out-patient care in a community, and identify unmet needs (“Quality Improvement,” n.d.). Working on the identified issues can lead to effective quality improvement.

Patient Safety Indicators (PSI)

  • Data relating to potentially avoidable harmful events
  • Increasing postoperative complications
  • The increasing average length of hospital stay
  • PSIs evaluate efficiency and effectiveness issues
  • Patient safety initiatives improve the quality of care

PSIs provide data relating to potentially avoidable safety incidences hindering quality care improvement. The practice setting has recorded an increasing rate of postoperative complications. The metrics can guide the organization in evaluating efficiency and effectiveness issues (“Quality Improvement,” n.d.). The organization is also facing the problem of long hospital stays, increasing operational costs significantly (Baek et al., 2018).

Build Knowledge and Leadership for Patient Safety

  • Center for Patient Safety
  • Specifying national patient safety goals
  • Tracking implementation progress for the goals
  • Issuing an annual patient safety report
  • A sound understanding of medical errors

The U.S. Congress should make annual care quality reports addressed to the president. The institution should also set a research agenda, goals, funding sources, and evaluation methods to develop a sound understanding of errors (Institute of Medicine, 2000; Gracia et al., 2019). Dissemination of patient safety information is also critical to success.

Adopt Error Reporting Systems

  • Error reporting systems facilitate data collection
  • The systems can be public or private
  • Some programs can report medication errors
  • Nurses can benefit from reporting programs
  • Data analysis is vital to quality improvements

Medical error reporting systems remain a crucial way of collecting medical errors data. Healthcare providers can benefit from public and private systems. Nurses can utilize the programs to communicate the medication faults they encounter in their practice settings (Institute of Medicine, 2000). Some options are broad-based, making them useful to other healthcare practitioners. The data analysis is required to make insightful improvements.

Protect Voluntary Reporting Systems from Legal Discovery

  • The fear of litigation hinders voluntary error reporting
  • Many errors go unreported
  • Removal of legal consequences for voluntarily reported errors
  • Reported errors provide a learning opportunity
  • The strategy can minimize medical errors

Significant legal constraints are making it challenging to protect voluntary error reporting systems from legal discovery. Healthcare organizations are concerned that reporting medical errors can increase the risk of legal action (Institute of Medicine, 2000). Therefore, numerous errors remain unreported. Removing legal consequences for open disclosure can encourage care providers to publish error reports.

Set Performance Standards and Expectations for Patient Safety

  • Defining minimum acceptable performance levels
  • Developing safety expectations for providers
  • Nurses should develop performance values and norms
  • Promoting patient safety
  • Controlling costs and enhancing quality care

Performance standards define the minimum acceptable service levels for primary care nurses and other healthcare professionals. The set levels will guide the hospital to form safety expectations among providers and consumers (Institute of Medicine, 2000). The values and norms set by staff members will depend on the established benchmarks aimed at promoting patient safety, controlling costs, and enhancing quality care.

Creating Safety Systems in Healthcare Organizations

  • Adopting strategies from high-risk industries
  • Continuous patient safety improvement
  • Adopting non-punitive error-reporting systems
  • Interdisciplinary team training programs
  • Developing a safety culture

Healthcare providers are yet to implement quality improvement strategies used in other high-risk industries. Hospitals and medical care centers should collaborate with their staff to continually improve patient safety programs (Institute of Medicine, 2000). Organizations should also adopt non-punitive error-reporting and analysis systems. Establishing interdisciplinary team training programs, such as simulations, can improve patient safety.


  • The practice setting faces significant safety issues
  • IOM has published useful reports
  • The reports have informed the public
  • Report recommendations address the identified challenges
  • A system approach to errors solves the problem

In summary, the IOM has published several reports highlighting major quality issues facing the healthcare sector and proposing practical solutions. The reports’ recommendations can address the identified quality and patient safety problems in the selected practice setting. A systemic approach to medical errors and collaboration among critical stakeholders can address the challenges.


Baek, H., Cho, M., Kim, S., Hwang, H., Song, M., & Yoo, S. (2018). PLoS One, 13(4), e0195901. Web.

Gracia, J. E., Serrano, R. B., & Garrido, J. F. (2019). BMC Health Services Research, 19(1), 640. Web.

Institute of Medicine. (2000). To err is human: Building a safer health system (vol. 627). (M. S. Donaldson, J. M. Corrigan, & L. T. Kohn, (Eds.). National Academies Press.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academy Press.

(n.d.). AHRQ. Web.

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