1114237 – Jones & Bartlett Learning ©

delivery of medical care was increasing in complexity
and the process of delivering care was about to move
into the computer age. This is important because today
caregivers are working in a significantly more complex
environment with an associated increased risk of error
and system failure—and the consequences of error are
more severe (Guarinoni, Petrucci, Lancia, & Motta,

The amenities of care speak to the patient’s interest in
being treated in comfortable, clean surroundings while
the ethical principles speak to the provider’s ethical
conduct in delivering care and his/her interest in
furthering societal and organizational well-being (or
effectiveness). A related, but more focused, view of
quality represents two fundamental questions about any
clinical service, procedure, or activity occurring in a
health care setting: (1) “are the right things done?” and
(2) “are things done right?” The first question assesses
the effectiveness of clinical care; the second considers
the efficiency of care services. Importantly, the
performance of health care organizations depends on
both its effectiveness and efficiency.

In 2001, Crossing the Quality Chasm (IOM, 2001),
proposed that health care should be: “safe, effective,
patient-centered, timely, efficient, and equitable” (pp. 5–
6). These six dimensions of care are addressed through
a variety of methodologies and metrics—many of which





1114237 – Jones & Bartlett Learning ©

are measured in the eyes of the beholder, i.e., the patient
and the system simultaneously. In the past, the patient
perspective was not part of the equation. Since the IOM
report, best practices are to include the patient and the
populations served as part of the health care team. Per
the IOM (2001) report, effectiveness is defined as
“providing services based on scientific knowledge to all
who could benefit and refraining from providing services
to those not likely to benefit (avoiding underuse and
overuse)”; and efficiency is defined as “avoiding waste,
in particular waste of equipment, supplies, ideas, and
energy” (p. 6). These concepts will be expanded upon in
the next section.




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