Qual Saf Health Care 13:407-409 doi:10.1136/qshc.2004.012765
  • Editorial
  • Quality improvement in the US and UK

The improvement horse race: bet on the UK

  1. D M Berwick
  1. Correspondence to:
 D M Berwick
 Institute for Healthcare Improvement, 375 Longwood Avenue, 4th Floor, Boston, MA 02215, USA;

    The task of building the best healthcare system in the world is well started in the UK

    Place your bets. Both the UK and the US are struggling to improve their troubled healthcare systems. Which is more likely to succeed? The two countries are strikingly similar in the problems they face, and equally dissimilar in their plans of action. I am a fan of both but, when bets are placed, my money will be on the UK.

    The best problem list for either country is probably the one in the landmark 2001 report “Crossing the Quality Chasm” issued by the Institute of Medicine (IOM), a branch of America’s National Academies of Science.1 Summarizing decades of health services research and literally thousands of studies, the Chasm report recommended six “aims for improvement” as targets for the redesign of healthcare systems:

    • safety (reducing medical injuries to patients);

    • effectiveness (increasing the reliability of evidence based care);

    • patient centeredness (giving patients and carers far more voice, control, and competence in self-management);

    • timeliness (reducing waits and delays throughout the system);

    • efficiency (reducing the total cost of care); and

    • equity (closing racial and socioeconomic gaps in health status).

    Rearranging the first letters, some organizations have taken to calling these the “S-T-E-E-E-P” goals.

    Although the IOM’s report addressed only American health care, its findings—and especially the six aims for improvement—pertain well to the UK and the NHS. The ongoing massive UK effort to improve the NHS—launched as the so-called “Modernisation Plan” in 1997—has involved massive new investments (raising the total UK expenditures on health care from its starting place of about 6.5% of the GDP closer to the EU average of about 8.5%; compared with 15% in the US!) and the creation of focused strategic plans—National Service Frameworks—that lay out dozens of …

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