Quality of care in obstetrics.(MASTER CLASS)(Clinical report)

Patient safety has become an emphasized area of medicine in recent years. This is not to suggest that the issue of patient safety is new to medicine. Historically, it has been assumed to be a natural part of good medicine and the provision of good medical care.

In 1999, the Institute of Medicine released shocking statistics, estimating that as many as 98,000 people die in any given years as a result of medical errors that occur in hospitals. In the now well-cited report "To Err Is Human: Building a Safer Health Care System," the IOM asserted that errors occur because good physicians and health care providers work within a bad system. It set a minimum goal of reducing errors by 50% over the next 5 years, and laid out a national agenda for improving patient safety.

This report was followed up by another IOM report published in 2001, "Crossing the Quality Chasm: A New Health Care System for the 21st Century." This report further defined what kind of change is needed to "close the quality gap." It provided overarching principles for clinicians, among others, and looked at how systems approaches can be used to implement change.

With both reports--two of many IOM studies and publications aimed at improving the nation's quality of care--a light has been shown nationally and internationally on the importance of not simply assuming that good quality care is part of medicine but, instead, emphasizing and critically analyzing the state of affairs relative to patient safety and quality of care.

Most of our institutions by now have ...