Patient Safety Now

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Publisher : CRC Press
ISBN 13 : 1000725731
Total Pages : 96 pages
Book Rating : 4.0/5 (7 download)

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Book Synopsis Patient Safety Now by : Suzette Woodward

Download or read book Patient Safety Now written by Suzette Woodward and published by CRC Press. This book was released on 2022-10-04 with total page 96 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the past decade or so, we have seen a multitude of improvement programmes and projects to improve the safety of patient care in healthcare. However, the full potential of these efforts and especially those that seek to address an entire system has not yet been reached. The current pandemic has made this more evident than ever. We have tended to focus on problems in isolation, one harm at a time, and our efforts have been simplistic and myopic. If we are to save more lives and significantly reduce patient harm, we need to adopt a holistic, systematic approach that extends across cultural, technological, and procedural boundaries. Patient Safety Now is about the fact that it is time to care for everyone impacted by patient safety, how we need to take the time to care for everyone in a meaningful way and how hospitals need to enable staff time to care safely. This book builds on the author’s two previous books on patient safety. Rethinking Patient Safety talked about ways in which we need to rethink patient safety in healthcare and describes what we’ve learned over the last two decades. Implementing Patient Safety talked about what we can do differently and how we can use those lessons learned to improve the way we implement patient safety initiatives and encourage a culture of safety across a healthcare system. Patient Safety Now unites the concepts, theories and ideas of the previous two books with updated material and examples, including what has been learned by patient safety specialists during a pandemic. Patient Safety Now provides the reader with a unique view of patient safety that looks beyond the traditional negative and retrospective approach to one that is proactive and recognizes the impact of conditions, behaviours and cultures that exist in healthcare on everyone. It is written not only for healthcare professionals and patient safety personnel, but for patients and their families who all want the same thing. Too often when things go wrong, relationships quickly become adversarial when in fact this can be avoided by recognizing that, rather than being in separate camps, there are shared needs and goals in relations to patient safety.

Rethinking Patient Safety

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Author :
Publisher : CRC Press
ISBN 13 : 1351651064
Total Pages : 166 pages
Book Rating : 4.3/5 (516 download)

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Book Synopsis Rethinking Patient Safety by : Suzette Woodward

Download or read book Rethinking Patient Safety written by Suzette Woodward and published by CRC Press. This book was released on 2017-03-27 with total page 166 pages. Available in PDF, EPUB and Kindle. Book excerpt: The vast majority of healthcare is provided safely and effectively. However, just like any high-risk industry, things can and do go wrong. There is a world of advice about how to keep people safe but this delivers little in terms of changed practice. Written by a leading expert in the field with over two decades of experience, Rethinking Patient Safety provides readers with a critical reflection upon what it might take to narrow the implementation gap between the evidence base about patient safety and actual practice. This book provides important examples for the many professionals who work in patient safety but are struggling to narrow the gap and make a difference in their current situation. It provides insights on practical actions that can be immediately implemented to improve the safety of patient care in healthcare and provides readers with a different way of thinking in terms of changing behavior and practices as well as processes and systems. Suzette Woodward shares lessons from the science of implementation, campaigning and social movement methods and offers the reader the story of a discovery. Her team has explored an approach which could profoundly affect the safety culture in healthcare; a methodology to help people talk to each other and their patients and to listen through facilitated safety conversations. This is their story.

Patient Safety

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Publisher : CRC Press
ISBN 13 : 143985226X
Total Pages : 254 pages
Book Rating : 4.4/5 (398 download)

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Book Synopsis Patient Safety by : Sidney Dekker

Download or read book Patient Safety written by Sidney Dekker and published by CRC Press. This book was released on 2016-04-19 with total page 254 pages. Available in PDF, EPUB and Kindle. Book excerpt: Increased concern for patient safety has put the issue at the top of the agenda of practitioners, hospitals, and even governments. The risks to patients are many and diverse, and the complexity of the healthcare system that delivers them is huge. Yet the discourse is often oversimplified and underdeveloped. Written from a scientific, human factors

Making Healthcare Safe

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Author :
Publisher : Springer Nature
ISBN 13 : 3030711234
Total Pages : 450 pages
Book Rating : 4.0/5 (37 download)

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Book Synopsis Making Healthcare Safe by : Lucian L. Leape

Download or read book Making Healthcare Safe written by Lucian L. Leape and published by Springer Nature. This book was released on 2021-05-28 with total page 450 pages. Available in PDF, EPUB and Kindle. Book excerpt: This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement’s founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today’s modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an “insider’s” tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care.

Patient Safety

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Author :
Publisher : Routledge
ISBN 13 : 1317083229
Total Pages : 340 pages
Book Rating : 4.3/5 (17 download)

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Book Synopsis Patient Safety by : Lorri Zipperer

Download or read book Patient Safety written by Lorri Zipperer and published by Routledge. This book was released on 2016-05-13 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Safety: Perspectives on Evidence, Information and Knowledge Transfer provides background on the patient safety movement, systems safety, human error and other key philosophies that support change and innovation in the reduction of medical error. The book draws from multidisciplinary areas within the acute care environment to share models that support the proactive changes necessary to provide safe care delivery. The publication discusses how the tenets of safety (described in the beginning of the book) can be actively applied in the field to make evidence, information and knowledge (EIK) sharing processes reliable, effective and safe. This is a wide-ranging and important book that is designed to raise awareness of the latent risks for patient safety that are present in the EIK identification, acquisition and distribution processes, structures, and systems of many healthcare institutions across the world. The expert contributors offer systemic, evidence-based improvement processes, assessment concepts and innovative activities to identify these risks to minimize their potential to adversely impact care. These ideas are presented to create opportunities for the field to design and use strategies that enable meaningful implementation and management of EIK. Their thoughts will enable healthcare staff to see EIK as a tangible element contributing toward sustainable patient safety improvements.

Understanding Patient Safety, Second Edition

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Author :
Publisher : McGraw Hill Professional
ISBN 13 : 0071808124
Total Pages : 501 pages
Book Rating : 4.0/5 (718 download)

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Book Synopsis Understanding Patient Safety, Second Edition by : Robert Wachter

Download or read book Understanding Patient Safety, Second Edition written by Robert Wachter and published by McGraw Hill Professional. This book was released on 2012-05-23 with total page 501 pages. Available in PDF, EPUB and Kindle. Book excerpt: Complete coverage of the core principles of patient safety Understanding Patient Safety, 2e is the essential text for anyone wishing to learn the key clinical, organizational, and systems issues in patient safety.The book is filled with valuable cases and analyses, as well as up-to-date tables, graphics, references, and tools -- all designed to introduce the patient safety field to medical trainees, and be the go-to book for experienced clinicians and non-clinicians alike. Features NEW chapter on the critically important role of checklists in medical practice NEW case examples throughout Expanded coverage of the role of computers in patient safety and outcomes Expanded coverage of new patient initiatives from the Joint Commission

Patient Safety

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Author :
Publisher : John Wiley & Sons
ISBN 13 : 1444348078
Total Pages : 430 pages
Book Rating : 4.4/5 (443 download)

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Book Synopsis Patient Safety by : Charles Vincent

Download or read book Patient Safety written by Charles Vincent and published by John Wiley & Sons. This book was released on 2011-07-20 with total page 430 pages. Available in PDF, EPUB and Kindle. Book excerpt: When you are ready to implement measures to improve patient safety, this is the book to consult. Charles Vincent, one of the world's pioneers in patient safety, discusses each and every aspect clearly and compellingly. He reviews the evidence of risks and harms to patients, and he provides practical guidance on implementing safer practices in health care. The second edition puts greater emphasis on this practical side. Examples of team based initiatives show how patient safety can be improved by changing practices, both cultural and technological, throughout whole organisations. Not only does this benefit patients; it also impacts positively on health care delivery, with consequent savings in the economy. Patient Safety has been praised as a gateway to understanding the subject. This second edition is more than that – it is a revelation of the pervading influence of health care errors, and a guide to how these can be overcome. "... The beauty of this book is that it describes the complexity of patient safety in a simple coherent way and captures the breadth of issues that encompass this fascinating field. The author provides numerous ways in which the reader can take this subject further with links to the international world of patient safety and evidence based research... One of the most difficult aspects of patient safety is that of implementation of safer practices and sustained change. Charles Vincent, through this book, provides all who read it clear examples to help with these challenges" From a review in Hospital Medicine by Dr Suzette Woodward, Director of Patient Safety. Access 'Essentials of Patient Safety – Free Online Introduction': www.wiley.com/go/vincent/patientsafety/essentials

First, Do Less Harm

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Publisher : Cornell University Press
ISBN 13 : 0801464072
Total Pages : 304 pages
Book Rating : 4.8/5 (14 download)

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Book Synopsis First, Do Less Harm by : Ross Koppel

Download or read book First, Do Less Harm written by Ross Koppel and published by Cornell University Press. This book was released on 2012-04-23 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients' hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain, and in some areas are on the rise. In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the "market model" on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives. Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects-physicians, safety champions, or high level management-these chapters expand the list of "stakeholders" and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.

Improving Patient Safety

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Publisher : CRC Press
ISBN 13 : 0429647115
Total Pages : 284 pages
Book Rating : 4.4/5 (296 download)

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Book Synopsis Improving Patient Safety by : Raghav Govindarajan

Download or read book Improving Patient Safety written by Raghav Govindarajan and published by CRC Press. This book was released on 2019-01-15 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: Based on the IOM's estimate of 44,000 deaths annually, medical errors rank as the eighth leading cause of death in the U.S. Clearly medical errors are an epidemic that needs to be contained. Despite these numbers, patient safety and medical errors remain an issue for physicians and other clinicians. This book bridges the issues related to patient safety by providing clinically relevant, vignette-based description of the areas where most problems occur. Each vignette highlights a particular issue such as communication, human facturs, E.H.R., etc. and provides tools and strategies for improving quality in these areas and creating a safer environment for patients.

Patient Safety and Healthcare Improvement at a Glance

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Publisher : John Wiley & Sons
ISBN 13 : 1118361350
Total Pages : 144 pages
Book Rating : 4.1/5 (183 download)

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Book Synopsis Patient Safety and Healthcare Improvement at a Glance by : Sukhmeet Panesar

Download or read book Patient Safety and Healthcare Improvement at a Glance written by Sukhmeet Panesar and published by John Wiley & Sons. This book was released on 2014-06-16 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Safety and Healthcare Improvement at a Glance isa timely and thorough overview of healthcare quality writtenspecifically for students and junior doctors and healthcareprofessionals. It bridges the gap between the practical and thetheoretical to ensure the safety and wellbeing of patients.Featuring essential step-by-step guides to interpreting andmanaging risk, quality improvement within clinical specialties, andpractice development, this highly visual textbook offers the bestpreparation for the increased emphasis on patient safety andquality-driven focus in today’s healthcare environment. Healthcare Improvement and Safety at a Glance: • Maps out and follows the World Health OrganizationPatient Safety curriculum • Draws upon the quality improvement work of theInstitute for Healthcare Improvement This practical guide, covering a vital topic of increasingimportance in healthcare, provides the first genuine introductionto patient safety and quality improvement grounded in clinicalpractice.

Implementing Patient Safety

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Publisher : CRC Press
ISBN 13 : 1351235370
Total Pages : 234 pages
Book Rating : 4.3/5 (512 download)

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Book Synopsis Implementing Patient Safety by : Suzette Woodward

Download or read book Implementing Patient Safety written by Suzette Woodward and published by CRC Press. This book was released on 2019-09-11 with total page 234 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the last two decades across the globe we have seen a multitude of programs, projects and books to help improve the safety of patient care in healthcare. However, the full potential of these has not yet been reached. Most of the current approaches are top down, programmatic and target driven. These look at problems in isolation one harm at a time with simplistic solutions that fail to support a holistic, systematic approach. They are focused on collecting incident data and learning from failure using tools that are not fit for purpose in a complex nonlinear system. Very rarely do the solutions help build the conditions, cultures and behaviours that support a safer system and help the people involved work safely. Healthcare is stuck in a relentlessly negative approach to safety. Those working in patient safety and healthcare are struggling, and books on patient safety to date instruct the reader to continue doing the same things we have been doing for the last 20 years. This book uniquely combines the latest thinking in safety, including creating a balanced approach to learning from what works as a way to understand why it fails, together with the evidence on building a just culture, positive workplaces and working relationships that we now know are so important for safety. It helps people understand how to address issues despite their complexities and improve safety with practical ways to truly understand what day to day healthcare work is actually like, rather than what people imagine it is like. This book builds on the author’s first book Rethinking Patient Safety which exposed what we need to do differently to truly transform our approach to patient safety. It updates the reader further on the concepts explored in the first book but also vitally helps readers understand the ‘how’. Implementing Patient Safety goes beyond the rhetoric and provides the reader with ideas and examples for how the latest thinking can actually be achieved. It is based on the author’s personal experience of leading a national culture change campaign in the National Health Service for five years. The lessons arise from helping hundreds of organisations and people rethink and implement a whole new way of thinking about improving patient safety in healthcare.

Patient Safety

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Publisher : Springer Publishing Company
ISBN 13 : 9780826133465
Total Pages : 586 pages
Book Rating : 4.1/5 (334 download)

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Book Synopsis Patient Safety by : Jacqueline Fowler Byers

Download or read book Patient Safety written by Jacqueline Fowler Byers and published by Springer Publishing Company. This book was released on 2004-06-03 with total page 586 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides readers with both a foundation of theoretical knowledge regarding patient safety as well as evidence-based strategies for preventing errors in various clinical settings. The authors' goal is to help clinicians and administrators gain the skills and knowledge they need to develop safe patient practices in their organizations. Key topics include: An overview of evidence-based best practices for patient safety Clear explanation of important patient safety policies and legislation Innovative uses of technology such as computerized provider order entry, barcoding medications, and computerized clinical decision support systems The importance of an informed patient in preventing medical errors How to communicate with the public and the patient about errors if they occur Special patient safety concerns for children, the elderly, and the mentally ill

Safer Healthcare

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Publisher : Springer
ISBN 13 : 3319255592
Total Pages : 170 pages
Book Rating : 4.3/5 (192 download)

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Book Synopsis Safer Healthcare by : Charles Vincent

Download or read book Safer Healthcare written by Charles Vincent and published by Springer. This book was released on 2016-01-13 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors of this book set out a system of safety strategies and interventions for managing patient safety on a day-to-day basis and improving safety over the long term. These strategies are applicable at all levels of the healthcare system from the frontline to the regulation and governance of the system. There have been many advances in patient safety, but we now need a new and broader vision that encompasses care throughout the patient’s journey. The authors argue that we need to see safety through the patient’s eyes, to consider how safety is managed in different contexts and to develop a wider strategic and practical vision in which patient safety is recast as the management of risk over time. Most safety improvement strategies aim to improve reliability and move closer toward optimal care. However, healthcare will always be under pressure and we also require ways of managing safety when conditions are difficult. We need to make more use of strategies concerned with detecting, controlling, managing and responding to risk. Strategies for managing safety in highly standardised and controlled environments are necessarily different from those in which clinicians constantly have to adapt and respond to changing circumstances. This work is supported by the Health Foundation. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The charity’s aim is a healthier population in the UK, supported by high quality health care that can be equitably accessed. The Foundation carries out policy analysis and makes grants to front-line teams to try ideas in practice and supports research into what works to make people’s lives healthier and improve the health care system, with a particular emphasis on how to make successful change happen. A key part of the work is to make links between the knowledge of those working to deliver health and health care with research evidence and analysis. The aspiration is to create a virtuous circle, using what works on the ground to inform effective policymaking and vice versa. Good health and health care are vital for a flourishing society. Through sharing what is known, collaboration and building people’s skills and knowledge, the Foundation aims to make a difference and contribute to a healthier population.

Crossing the Quality Chasm

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Publisher : National Academies Press
ISBN 13 : 0309132967
Total Pages : 359 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Crossing the Quality Chasm by : Institute of Medicine

Download or read book Crossing the Quality Chasm written by Institute of Medicine and published by National Academies Press. This book was released on 2001-07-19 with total page 359 pages. Available in PDF, EPUB and Kindle. Book excerpt: Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Patient Safety in Emergency Medicine

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Author :
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 9780781777278
Total Pages : 456 pages
Book Rating : 4.7/5 (772 download)

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Book Synopsis Patient Safety in Emergency Medicine by : Pat Croskerry

Download or read book Patient Safety in Emergency Medicine written by Pat Croskerry and published by Lippincott Williams & Wilkins. This book was released on 2009 with total page 456 pages. Available in PDF, EPUB and Kindle. Book excerpt: With the increased emphasis on reducing medical errors in an emergency setting, this book will focus on patient safety within the emergency department, where preventable medical errors often occur. The book will provide both an overview of patient safety within health care—the 'culture of safety,' importance of teamwork, organizational change—and specific guidelines on issues such as medication safety, procedural complications, and clinician fatigue, to ensure quality care in the ED. Special sections discuss ED design, medication safety, and awareness of the 'culture of safety.'

ABC of Patient Safety

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Publisher : John Wiley & Sons
ISBN 13 : 1444312693
Total Pages : 64 pages
Book Rating : 4.4/5 (443 download)

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Book Synopsis ABC of Patient Safety by : John Sandars

Download or read book ABC of Patient Safety written by John Sandars and published by John Wiley & Sons. This book was released on 2009-04-08 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: This brand new title in the popular ABC series offers an up-to-date introduction on improving patient safety in primary and secondary care. The ABC of Patient Safety covers an area of increasing importance in healthcare and provides a clear description of the underlying principles that influence practice. Patient safety is now an integral part of the training for all Foundation doctors and is rapidly becoming a component of many undergraduate and postgraduate exams, including the nMRCGP. This book is an ideal companion for this training. A wide variety of clinical staff and managers in primary and secondary care will find this book an essential text, offering an ideal theoretical and practical aid to patient safety. GPs and practice managers will find this book of particular interest, as well as medical and nursing students.

To Err Is Human

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Author :
Publisher : National Academies Press
ISBN 13 : 0309068371
Total Pages : 312 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis To Err Is Human by : Institute of Medicine

Download or read book To Err Is Human written by Institute of Medicine and published by National Academies Press. This book was released on 2000-03-01 with total page 312 pages. Available in PDF, EPUB and Kindle. Book excerpt: Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine