Ever since the healthcare debacle of the early Clinton years, the voices calling for change in the US healthcare system have been quite muted. However, this past month, the Institute of Medicine, which was established in 1970 by the National Academy of Sciences to advise the federal government on matters related to the health of the public, published a report entitled Crossing the quality chasm: a new health system for the 21st century .1The report describes serious shortcomings in US healthcare, including medical errors of both of co-mission and omission, as well as the failure to practice medicine in adherence with established evidence. These are a result of the growing complexity of science and technology, an increase in the percentage of children and adults with chronic conditions, and a poorly organised healthcare delivery system. Despite the dedicated and high quality people who work within the delivery system, they cannot compensate for its shortcomings. Recognising that the American healthcare system is in need of fundamental change, the group articulates a new vision for it. The report espouses six aims, suggesting that the system should be: …