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United States spends more on health care than other countries yet frequently the care provided does not result in good health outcomes. USA lags on measures related to primary care services and its quality of care needs improvement

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In 2001, The Institute of Medicine released Crossing the Quality Chasm: A New health System for the 21st Century.
Some of the factors that according to the IOM affect USA's inability to provide consistent high quality of care are:
- Growing complexity of health care.
- Quickly development of technological advances.
- Inability to meet rapid changes.
- Increased longevity amongst population.
- Fragmented delivery system that lacks coordination.

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Advances must begin with all health care constituencies--health professionals, federal and state policy makers, public and private purchasers of care, regulators, organization managers and governing boards, and consumers--committing to a national statement of purpose for the health care system as a whole. In making this commitment, the parties would accept as their explicit purpose “to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.”

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The parties also would adopt a shared vision of six specific aims for improvement. These aims are built around the core need for health care to be:
- Safe
- Effective
- Patient Centered
- Timely
- Efficient
- Equitable

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Healthcare quality is a complex topic, but it can be defined, measured, and improved upon. This highlights the necessity to understand all its dimensions fully.