Quality, Safety, Accountability, and Medical Director Responsibilities

Introduction

The challenges found in end-stage kidney disease (ESKD) facilities in the United States mirror fundamental shortcomings in the American health care system in general, as described in the Institute of Medicine (IOM) 2001 report Crossing the Quality Chasm: A New Health Care System for the 21st Century . The IOM concludes that “the American health care delivery system is in need of fundamental change.” The IOM proposes six key goals for the 21st-century health care system: safe, effective, patient centered, timely, efficient, and equitable.

The IOM points out that much of the quality “chasm” that currently exists in health care delivery is due to misaligned incentives between health care systems, payers, medical professionals, patients, technology, education, and legal liability. Multiple interrelated dimensions of health care delivery must be addressed, improved, and aligned to improve the quality chasm. Several of these dimensions have immediate relevance to the care of dialysis patients and include quality, safety, and accountability.