Affiliation: Dr. Berwick is the former president and CEO of the Institute for Healthcare Improvement and former Administrator of the Centers for Medicare & Medicaid Services.
In its landmark 2001 report, Crossing the Quality Chasm, the Institute of Medicine not only documented high rates of defect in American health care but also wrote, stunningly, “In its current form, habits, and environment, American health care is incapable of providing the public with the quality care it expects and deserves.”1
The term incapable is an indictment: profound, uncomfortable, and warranted. America's forms of care are largely soloists, but patients need symphonies; its habits of care are of excess, but society needs elegance; the environment preserves the status quo, instead of encouraging change. That US health care nonetheless manages to work as well as it does is testimony to the dedication of professionals and to a workforce that somehow makes the best of a bad situation.
Berwick DM. ACOs—Promise, Not Panacea. JAMA. 2012;308(10):1038–1039. doi:10.1001/2012.jama.11486