Box 3 Simple rules for the design of the 21st century healthcare system in the United States

Traditional approachNew rule
Care is based primarily on visitsCare is based on continuous healing relationships
Professional autonomy drives variabilityCare is customised according to patients' needs and values
Professionals control careThe patient is the source of control
Information is a recordKnowledge is shared and information flows freely
Decision making is based on training and experienceDecision making is evidence based
“Do no harm” is an individual responsibilitySafety is a system property
Secrecy is necessaryTransparency is necessary
The system reacts to needsNeeds are anticipated
Cost reduction is soughtWaste is continually decreased
Preference is given to professional roles over the systemCooperation among clinicians is a priority
  • Source: Institute of Medicine Committee on Quality of Health Care in America11