Conceptualization and Definitions of Quality

The science of health care improvement had advanced dramatically through the work of pioneers such as Avedis Donabedian and health care providers who championed systematic use of evidence-based medicine. This work helped lay the groundwork for an emerging body of consensus measures based on evidence that provided important tools for assessing the care delivered by health care providers. However, it was not until after the publication of the IOM reports that a paradigm shift began to emerge, one that provided new frameworks for assessing quality and safety and for initiating the overdue transformation of a care delivery system that still fails to provide safe and effective care.