The previous chapter deals with the healthcare professionals who are found in healthcare teams. Now we turn to the person at the center of each team, namely, the patient. Patients sometimes are referred to as clients by some healthcare professionals, especially social workers. By using the word patient we do not mean to suggest any disagreement with those who prefer to use the word client. Specifically, we do not mean to imply that all patients are or should be passive or dependent. Of course, sometimes patients are dependent—for example, when they are acutely ill and cannot think and act normally, say, because of severe chest pain or the effects of a life-threatening infection. But these examples of dependency are unusual. Most of the time patients are fully capable of making decisions about their care. Nurses, physicians, pharmacists, and most other healthcare professionals ordinarily use the word patient when referring to a person who is receiving health care. Since these professionals comprise most of the readership for this book, we use the word patient too.
Others may refer to patients as consumers or customers. If we were thinking of people who are choosing health insurance or choosing which clinic to select for care—especially if they have no immediate need for health care—these terms might be appropriate. But this is a book for people who are providing care, not a book for people who are marketing or selling health insurance or health services. We have more to say about consumers and consumerism below.
In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm (Institute of Medicine, 2001). This book changed how the quality of health care is conceptualized in the healthcare professions in the United States. Echoes from its pages are still heard today and probably will continue to be heard for many more years. Among other innovations, the IOM report provided a functional definition of quality that has become the standard starting point for endeavors to measure healthcare quality and improve it.
Prior to the publication of Crossing the Quality Chasm, the most commonly quoted definition of quality in health care came from an IOM report issued 11 years earlier. That report defined quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (Institute of Medicine, 1990, p. 21). While the 1990 definition was an improvement on earlier definitions and served its purposes, in hindsight the definition is remarkable for what it leaves out, namely, any reference to patients and to the goals that patients have in seeking health care. The 1990 definition is crafted from the viewpoint of healthcare professionals. It implies, without directly stating so, that defining healthcare quality is a task appropriate for individuals who can judge whether health services "are consistent with professional knowledge" and that their proper central concern is ...