Revisiting the quality chasm.

Strategic plans provide the roadmap by which organizations achieve their vision. To effectively serve as that roadmap, strategic plans must have certain essential characteristics. These include the ability to inspire and motivate while remaining action-oriented and understandable to all personnel. More than a decade ago, in Crossing the Quality Chasm, the Institute of Medicine (IOM) suggested organizing transformational efforts in 6 domains: Safety, Effectiveness, Patient-Family Centeredness, Timeliness, Efficiency, and Equity. Recently 2 additional domains have been added: Access and Care Coordination. Since that time, many quality and safety efforts and hospital strategic plans have been built around those domains. Although the IOM structure is succinct, the domains important, and the strategic vision thorough, it did not inspire or motivate our staff sufficiently to be the framework for change in our hospital. Therefore, Nationwide Children’s Hospital developed a strategic plan, organized entirely from the point of view of the patient and family. We believe this quality and safety strategic plan is readily understandable by all, more motivational because of its direct link to the patient, and offers an effective alternative to the IOM domains of transformative strategic thinking (Table 1).