The Institute of Medicine (IOM)

The Institute provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large. They have produced 29 reports from 1990 to 2006 on women's health issues but have not directly addressed perinatal care in this country.

IOM describes our practice environment as a place in which there is "more to know, more to do, more to manage, more to watch, and more people involved than ever before. Faced with such rapid changes, the health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately" and concluded that "the burden of harm conveyed by the collective impact of all our healthcare quality problems is staggering." (Chassen et al, 1998)

As a result of this work, an urgent call for fundamental change to close the quality gap was made. Eight years later, the IOM expressed frustration with the slow pace of improvement despite the body of knowledge and resources that have become available in the interim. Why?

The IOM concluded that the current system is:

• Fragile, voluntary and consensus-based, and therefore inherently conservative of the status quo and unlikely to produce bold change
• Controlled by a limited number of stakeholders who are not inclusive and inherently conservative of the status quo
• Accommodating to limited measures with significant gaps but not to comprehensive programs
• Wasteful and inefficient, with duplications and inconsistencies
• Inadequately interested in the public good

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