CROSSING THE QUALITY CHASM: OPPORTUNITIES FOR THE EMPLOYEE ASSISTANCE
PROGRAM FIELD

Allen Daniels, Ed.D

Lisa Teems, D.Min

Christopher Carroll, M.Sc

Evelyn Santiago-Fernandez, BA

(The authors would like to acknowledge the generous assistance and
support offered by Tim Stockert of the Council on Accreditation, Frank
Pirhalla of the Federal Aviation Administration EAP, and Ron
Manderscheid of SAMHSA's Center for Mental Health Services. Thank you
for making this a reality.)

The core services and values of Employee Assistance Programs (EAPs) have
undergone many changes throughout their six-decade history. Originally
designed as an occupational resource to address workforce performance
and impairment due to alcoholism, the field has expanded into a more
comprehensive range of behavioral health services. In the wake of these
changes, the field finds itself in search of a true identity in order to
establish its survival as a distinct profession. This article proposes a
new quality framework for the future directions of the EAP field.

***A BRIEF HISTORY***

In the 1930s and 40s, informal occupational alcohol programs arose as a
response to employees who were alcohol-impaired at the workplace. They
were primarily influenced at that time by the growth of Alcoholics
Anonymous (White and Sharar, 2003). More formalized programs arose in
the next few decades as an understanding of addictions began to emerge.
In the 1950s, there was a shift away from industrial alcohol programs
towards employee assistance programs as companies began to extend their
alcohol programs to also cover employees that were experiencing mental
health problems (Presnall, 1981; Steele and Trice, 1995). This movement
was further influenced in part, by the Federal Government's passage of
the Hughes Act in 1970 and the resulting creation of the National
Institute on Alcohol Abuse and Alcoholism. It was the focus of the
Institute to break down the stigma associated with addiction. By
offering "broad brush" programs, employees with alcohol problems might
more readily seek help through programs not identified solely with
alcoholism. This shift marked the employee assistance field's first
major focus away from substance abuse and into the larger behavioral
health arena. A professional specialty for EAPs also emerged at this
time.

In the next few decades, EAPs witnessed phenomenal growth. There were
just a handful of companies offering occupational alcohol programs in
the 1940s. By 1959 there were approximately 50 programs and 175 by 1965.
The estimate climbed to 12,000 by 1985 (White and Sharar, 2003). In
2001, it was estimated that 65 million people in the US were covered by
EAPs and that there were over 7,000 professionals working in the field
(Oss, 2001). Between the late 1970s and now, however, there were a
number of EAP trends that have continued to affect the identity of the
field.

One trend has been the manor in which the programs are provided. They
have evolved from programs staffed by in-house personnel or by local
community based service providers to programs primarily contracted out
to large behavioral healthcare companies and staffed by a vast network
of EAP affiliates. Another trend has been the expansion of services and
products provided by EAPs. They now offer services far beyond the
traditional scope of these programs including drug-free workplace
delivery, workplace violence interventions, a full range of work/life
and wellness assistance, management of behavioral health benefits,
disability determinations, financial and legal consultations, and other
specialty programs requested by employers. These new products signal not
only a shift away from addictions as the single focus of services but
also a shift away from the individual employee to the
company/organization as the primary client. This spectrum of services
has resulted in a new range of service models such as the Full Service
EAP, Integrated Program, Wrap-Around EAP, Compliance EAP, and
Peer-Assistance Program. (Steele, 1998).

Another trend worth noting is the development and strengthening (through
licensing and certification) of a professional EAP specialty. Finally,
there has been an effort to standardize the identity and practice of
EAPs through the creation of an "EAP Core Technology" (Roman and Blum,
1988), which has been supported by the Employee Assistance Professionals
Association, through the accreditation and licensing of EAPs, and
through the promulgation of regulations and laws that impact the field.

***IMPLICATIONS AND CHALLENGES***

The evolution of the EAP field has been dynamic. While the industry has
grown and been strengthened by these changes, it is also forced to face
a number of challenges and struggles created by them. Because of the
limitless provision of different services and products, EAPs are often
seen as "ill defined and amorphous" (Blair, 2002) creating confusion for
both the buyers and users of the programs. There is fragmentation with
regard to the industry's core functions and responsibilities. As is
evident in its history, the EAP field has long struggled to determine
its role in both the occupational and behavioral health care delivery
systems. The evolving history of these programs has fostered a role that
lies somewhere between the occupational and healthcare field. This
diversity of role has led to a broad and inclusive mission, with a less
focused set of organizing principles or guidelines. Quality and
accountability efforts have resulted in standards for operation, but do
not represent fundamental principles.

There is intense competition by the providers of EAP services resulting
in quality-threatening low pricing and lack of collaboration around
basic core definitions and performance measures. In addition, there are
no agreed upon standard benchmarks for measuring performance across
providers and the various EAP models. Similarly, despite the development
of accreditation standards in this industry, it has not yet been
determined whether they will lead to standardization and improved
quality. Purchasers and providers of EAP services are not yet
knowledgeable enough about what constitutes quality programming to use
standards in making decisions.

The EAP field is missing a substantial empirical base and finds itself
unable to defend much of the effectiveness of its activities and
identify best practices. This is a dangerous position given the current
evidence-based focus linking practice and outcomes, and performance and
funding. "It \[the EAP field\] lacks a foundation of rigorous scientific
studies and has no identified academic discipline at its foundation.
There is less methodologically sound research in the EA field than any
comparable field of behavioral health or social service (White and
Sharar, 2003)."

Given the current state of the industry, the principle challenge that
lies ahead for the EAP field is to define its place within the larger
scope of behavioral healthcare, which is at the heart of its activity
and history. Finding that place will require the integration of
substance abuse and mental health care with employer-based interventions
and the overall improvement of employee productivity and well-being. The
development of a blueprint and a vision for EAP system design and a set
of core principles that fosters evolving change anchored on quality
practices and clearly defined roles are required.

***OPPORTUNITIES***

There are a series of recent reports that help provide a framework to
address the challenges and opportunities that face the behavioral health
field in general and the EAP field specifically. These include the
*Surgeon General's Report on Mental Health* (1999), the President's New
Freedom Commission report *Achieving the Promise: Transforming Mental
Health Care in America* (2003), and the Institute of Medicine's (IOM)
report; *Crossing the Quality Chasm: A New Health System for the 21^st^
Century* (2001). Together these studies provide an excellent summary of
the issues germane to the science, policy, and service issues for
behavioral health. The work of the IOM is particularly relevant to this
discussion of finding the EAP's place in the larger behavioral health
fields.

In a series of reports, the IOM has addressed the quality of healthcare
in America. Beginning with a study of medical errors, they have
concluded too many patients die or are harmed each year by the care that
is intended to help them (*To Err is Human*, 2000). This report was
followed by the anchor report for the series, *Crossing the Quality
Chasm* (2001). Key aspects of this report include a core set of **Six
Aims** which define quality health care systems, and **Ten Rules** for
how health care should be delivered. Subsequent reports in this series
have addressed the need to purchase health care based upon quality
indicators (*Leadership by Example: Coordinating Government Roles in
Improving Health Care Quality*, 2002) and in *Priority Areas for
National Action: Transforming Health Care Quality* (2003), the IOM
reviews priority conditions that show the greatest promise for quality
improvement.

The *Crossing the Quality Chasm* report argues that the American health
system is broken and in need of fundamental transformation. The Aims and
Rules outlined in the report provide useful tools to guide this change
and are beneficial to the EAP field in the examination of core
principles for the future. The Six Aims that are outlined include the
notions that healthcare should be:

-   Safe

-   Effective

-   Efficient

-   Equitable

-   Patient-centered

-   Timely.

These Aims serve as core values for health care services. Ten Rules are
also proposed for the delivery of health care. They are:

-   Care is based upon continuous healing relationships.

-   Customization is based upon patient needs and values.

-   The patient is the source of control.

-   Shared knowledge and the free flow of information are essential.

-   Decision making is evidence-based.

-   Safety is a system priority.

-   There is a need for transparency in all aspects of healthcare
    delivery.

-   Needs are anticipated.

-   The reduction of waste is ongoing.

-   Cooperation among clinicians is a priority.

A significant shortcoming of these reports is their failure to include
behavioral health and substance abuse as a focus. However, in 2004 the
IOM has begun a study *Crossing the Quality Chasm: Adaptation to Mental
Health and Addictive Disorders* ([www.iom.edu](http://www.iom.edu/)).
This study is a project jointly funded by federal and private sources as
well as mental health and substance abuse programs and has the potential
to build upon the other reports to guide the field. It is critical that
the EAP field take the opportunity to contribute to the findings and
implementation of the results.

***DEVELOPING A METHOD TO EXAMINE THE RELEVANCE OF THE QUALITY CHASM
REPORT FOR THE EAP INDUSTRY***

The findings and recommendations of the IOM's *Crossing the Quality
Chasm* report provide useful guidance for the EAP field as it develops
its blueprint and vision for the future. In order to evaluate its
relevance and to see if the Aims could in fact inform a design for the
EAP profession, a process was developed to map a crosswalk between the
Aims found in the Quality Chasm report and existing data sets currently
found in the EAP literature. It is recognized that there are many ways
to investigate how the EAP field aligns with the Quality Chasm report
and the larger healthcare industry. The method chosen for this effort
was to look at the EAP field's various standards, guidelines and
performance measures. Standards and measures are indications of what any
field of practice considers important, reveal its best practices, and
reflect the principle beliefs underlying its activities.

For this project, four different sets of standards/performance measures
were considered:

1.  Council on Accreditation's *Standards and Self-Study Manual for
    Employee Assistance Programs, 2^nd^ Edition*, 2003).

2.  Employee Assistance Professionals Association *Standards and
    Professional Guidelines for Employee Assistance Professionals*, 1999
    Edition

3.  EAP Joint Industry Alliance *Performance Measures, 3/10/03 Draft*

4.  Employee Assistance Professionals Association *International
    Programme Guidelines*, 1995

As a beginning step, each separate set of the standards and guidelines
listed above was mapped using a matrix (See Figure 1 below) that
contained the Quality Chasm Aims and Rules.

FIGURE 1

![](media/image1.wmf){width="5.995833333333334in"
height="5.388194444444444in"}

After completing this process, the results yielded a complex set of
overlapping standards. Based upon the voluminous amounts of data created
by this process, it was decided to concentrate first on the Aims found
in the Quality Chasm report. Each separate EAP standard, guideline, and
performance measure found in the four documents (almost 500 items) under
review was distributed under the Aim that was most identified with its
intention or meaning. This analysis was completed by a team of four
members having EAP and/or mental health backgrounds. Each set of
aggregated standards and guidelines was then discussed by the team to
make sure there was consensus on the placement of each item under the
appropriate Aim.

The results of this analysis yielded three questions:

-   Could the Aims of the Quality Chasm and the aggregation of EAP
    standards in that framework evaluate the work being performed by
    EAPs?

-   Do the standards and guidelines that exist in the EAP today
    incorporate the principles found in the Quality Chasm?

-   By linking the Aims/EAP standards matrix to the activities of the
    EAP profession, could they serve as a roadmap for guiding the future
    work of the field?

In order to interpret the lessons found in this data and begin to
address these questions, it was necessary to develop a framework that
encompassed the scope of work that is performed in the EAP field. Using
as a basis the list of EAP activities found in the U.S. Department of
Health and Human Services EAP's policy (HHS Personnel Instruction
792-2), the team developed a set of fundamental activities delivered by
EAPs. The final list incorporates all of the elements of the EAP Core
Technology as well as the functions described in the various standards
and guidelines that were examined. The activities were then divided
roughly according to the level of intervention/impact. These EAP
activities fell into five core areas/levels. They are:

-   ***Services provided for individuals.*** These include; assessment,
    referral, short-term problem solving, follow-up, referral and
    information, and collaboration with others (such as treatment
    facilities, HR staff, etc.) regarding case planning and outcomes.

-   ***Services provided for managers and supervisors.*** This includes
    assistance in referring troubled employees to the EAP, supervisor
    training and education, and management consulting.

-   ***Services provided for organizations.*** This level of activity
    includes violence prevention and crisis management, critical
    incident stress debriefing, group interventions, support groups,
    employee orientation and educational services, and special services
    (such as drug-free workplace, outplacement services, disability
    management or organizational development.)

-   ***Services in support of program operations/program administration
    activities.*** These activities apply to both a single specific EAP
    (whether provided by in-house or contracted staff) as well as to EAP
    vendors providing services to multiple organizations. These
    activities include: development of and adherence to policies and
    procedures (general policies as well as compliance with applicable
    laws and regulations), outreach/marketing and publicity, evaluation
    and quality improvement and assurance, web development and
    maintenance, staffing and professional development/other human
    resource activities, and development of program structure.

-   ***Services in support of developing and maintaining an EAP field
    and profession.*** These activities address the larger environment
    in which EAPs operate. They include the development of EAP
    standards/principles/performance measures, development and
    enforcement of licensing and credentialing mechanisms, development
    and implementation of academic standards, and legal and public
    policy development and interpretation.

Using this list of EAP activities/services and the Aims outlined in the
Quality Chasm report a grid was developed. This tool provides a
framework to examine how the established standards/guidelines are
interrelated to other EAP activities as well as the core aims. The EAP
standards/guidelines were then mapped to the grid to determine how
frequently the Quality Chasm Aims and EAP standards/guidelines applied
to the particular EAP activity. For the purpose of this report, the
total number of standards/guidelines is listed in each cell. (See Figure
2 below) In some cases, it was clear that standards/guidelines aligned
with more than one Aim. In this report, however, each was assigned to
only one Aim. (Note: a detailed analysis of the standards listed in each
category is available from the authors.)

FIGURE 2

  ---------------------------------------------------------------------------------------------------------
  ***EAP                 SAFE         CLIENT-CEN-TERED   EFFI-CIENT   EFFEC-TIVE   TIMELY      EQUIT-ABLE
  ACTIVITY/AIMS***                                                                             
  ---------------------- ------------ ------------------ ------------ ------------ ----------- ------------
  SERVICES PROVIDED FOR                                                                         
  INDIVIDUALS:                                                                                 

  Assessment                          17                 5            1            11           

  Referral               1            7                  3                                      

  Short-term problem                  2                                                         
  solving/counseling                                                                           

  Follow-up                                                                                     

  Information and                                                     1            1            
  referral                                                                                     

  Collaborations with    1                                            7            1            
  others (treatment                                                                            
  facilities, ER, etc.)                                                                        
  regarding specific                                                                           
  clients                                                                                      

  SERVICES PROVIDED FOR                                                                         
  SUPERVISORS AND                                                                              
  MANAGERS:                                                                                    

  Supervisory referral                2                                                         
  assistance                                                                                   

  Supervisory training                5                               1                         
  and education                                                                                

  Management consulting               6                                                         

  SERVICES PROVIDED FOR                                                                         
  ORGANIZATIONS:                                                                               

  Violence                                                                                      
  prevention/crisis                                                                            
  management                                                                                   

  Critical incident                   2                                            4            
  stress debriefings                                                                           

  Group interventions                                                                           

  Support groups                                                                                

  Employee orientations                                                                         

  Educational programs                6                               1                         

  Special services                                                                              
  (drug-free workplace,                                                                        
  outplacement,                                                                                
  disability, HIV/AIDS,                                                                        
  OD)                                                                                          

  SERVICES IN SUPPORT OF                                                                        
  PROGRAM                                                                                      
  OPERATIONS/PROGRAM                                                                           
  ADMINISTRATION                                                                               
  ACTIVITIES:                                                                                  

  Development of         109          7                  3            9                        5
  policies and                                                                                 
  procedures                                                                                   

  Outreach/Marketing and                                 3            5                         
  publicity                                                                                    

  Evaluation and quality 10           5                  12           58           6           2
  assurance                                                                                    

  Web development and    1                                            1            2            
  maintenance                                                                                  

  Referral (clinical)    1                               1            4                         
  resource development                                                                         
  and maintenance                                                                              

  Non-clinical                        3                  1            1                         
  collaborations                                                                               
  (unions, HR staff,                                                                           
  management,                                                                                  
  committees, etc.)                                                                            

  Staffing, ethics and   15           2                  9            70                        
  professional                                                                                 
  development                                                                                  

  Development and        8            17                 5            11           3           8
  maintenance of program                                                                       
  structure/design (such                                                                       
  as budget, advisory                                                                          
  committees, board of                                                                         
  directors)                                                                                   

  SERVICES IN SUPPORT OF                                                                        
  DEVELOPING AND                                                                               
  MAINTAINING AN EAP                                                                           
  FIELD AND PROFESSION:                                                                        

  Development of EAP                                                                            
  standards, principles,                                                                       
  performance measures                                                                         

  Development and                                                                               
  enforcement of                                                                               
  licensure and other                                                                          
  credentialing                                                                                
  mechanisms                                                                                   

  Development and                                                                               
  implementation of                                                                            
  academic requirements                                                                        
  for EAP professionals                                                                        

  Development and                                                                               
  interpretation of laws                                                                       
  and public policy                                                                            
  impacting EAPs                                                                               

  **Totals (482)**       **146**      **81**             **42**       **170**      **28**      **15**

  **% of Total**         **30.29%**   **16.80%**         **8.71%**    **35.27%**   **5.81%**   **3.11%**
  ---------------------------------------------------------------------------------------------------------

The summary of these findings provides a resource to evaluate the
relationship of EAP services to the overall framework of the quality of
healthcare. The grid provides a quick report card on how current EAP
standards and guidelines reflect the principles of the Quality Chasm
report. It can be seen, for example, that the EAP field has not
conceptualized any guidelines/strategies for the development and
maintenance of the larger EAP environment. It is also evident that
current EAP standards and guidelines do very little to address the areas
efficiency, timeliness, and equitability.

The grid also provides the EAP field with the opportunity to integrate
its standards/guidelines into the larger healthcare arena. One can
compare, for example, similar activities (assessment, referral, etc.) of
other behavioral healthcare industries. This bridge between the EAP and
healthcare fields provides an opportunity for common analysis and
comparison of services and outcomes. Finally, this grid also offers a
tool to monitor changes in the field and develop strategic plans for
operations and improvements.

***DISCUSSION: THE QUALITY CHASM AND EMPLOYEE ASSISTANCE PROGRAMS***

The Quality Chasm report, when applied to the EAP profession, offers
clear goals and aims for a major quality transformation. It is
instructive to evaluate how the field currently aligns with these ideas
so that can they be built upon to establish a framework for continuously
improving quality among EAPs. This crosswalk between EAP program
activities and the six Aims provides a framework to evaluate the
standards for accreditation and other guidelines used in the field. It
also offers a systematic review of the current state of EAP services and
their relationship to the larger behavioral health and general
healthcare field. It is noted that there may be some inefficiencies in
the application of accreditation standards due to the apparent
redundancy in some of the categories.

When interpreted for the EAP field, the six Aims of the Quality Chasm
offer a set of over-arching principles. By looking at how each of the
current EAP standards and guidelines generally aligned with the Aims,
they also reveal a framework for the future development of standards,
performance measures, and the quality improvement of EAPs. Below is a
discussion of each Quality Chasm Aim, how it can be interpreted as a
guiding principle for the EAP field as well as a summary of the
categories of standards and guidelines that currently align to each.

**AIM 1- SAFE:**

-   ***Guiding principle for the EAP profession:*** Services should be
    provided in an emotionally and physically safe, compassionate,
    trusting, and caring environment for all clients and staff.

-   ***Examples of the types of*** ***EAP standards and guidelines that
    align with this aim:*** Anything having to do with integrity and
    protection. Complaints and risks and grievances are responded to.
    There are reports, policies and procedures assuring safety. There is
    safety regarding research. There is compliance with laws and
    regulations. The physical safety of buildings/facilities is assured.
    Staff ethics are assured and affiliates follow the same rules.
    Confidentiality and record keeping (including statement of
    understanding and electronic issues) policies and procedures are in
    place and adhered to.

-   ***Commentary:*** Safety is a central component of all employee
    roles and functions. In the EAP field, it is essential that all
    aspects of care and intervention are safe. Furthermore, the role of
    the EAP in company operations and policies must stress the aim of
    safety at all levels.

**AIM 2- EFFECTIVE:**

-   ***Guiding principle for the EAP profession:*** EAP services are
    based on established best practices. Care is also provided in
    response to and respectful of individual choice and preference. The
    EAP refers clients to programs that are similarly up-to-date and
    using evidence-based practices.

-   ***Examples of the types of EAP standards and guidelines that align
    with this aim:*** There should be data/feedback/audits and
    evaluations and they should contain certain items and follow certain
    formats and timeframes. Personnel/staff requirements and
    training/continuing education plans and activities assure effective
    delivery and are in line with current evidence-based practices.
    Having boards of directors and administrative structures make for an
    effective organization. Program theories/philosophy/structure
    includes effectiveness. Promotion and outreach efforts are effective
    in reaching targeted populations.

-   ***Commentary:*** The role of effectiveness is a central component
    of quality and outcomes in EAP activities. As the EAP field moves
    ahead it is crucial that an evidence base is adopted for all work.
    There is an increasing risk that employers may decide to purchase a
    trendy service that may not have an established evidence and
    effectiveness base.

**AIM 3- CLIENT/COMPANY-CENTERED:**

-   ***Guiding principle for the EAP profession:*** Programs utilize a
    highly individualized and comprehensive process of assessment and
    referral that includes each client's history, strengths, needs and
    vision of their own recovery. This assessment and referral process
    also gives attention to issues of culture, spirituality, trauma, and
    other similar factors. The EAP intervention plans for all clients
    respect their unique preferences, strengths and dignity. Services
    for the work site and organization (such as supervisor
    consultations, trainings, and crisis interventions) are also
    respectful of the organization's history, culture, and unique
    preferences.

-   

-   ***Examples of the types of EAP standards and guidelines that align
    with this aim:*** Assessments of clients is about their needs. EAP
    meets and works with managers to address troubled employees as well
    as provided training on how to refer to the program. There should be
    outreach individualized to the culture, clients, etc. Prevention
    services should be provided and have certain components. The
    philosophy of the program and program design are centered on
    clients/companies. EAP may provide unique kinds of services as
    needed such as DFW, CISM, OD, On-line/telephone counseling. There is
    an advisory function/body available to the EAP. There should be
    needs assessments/analysis conducted to determine needs of
    clients/organizations. Policies and procedures should meet
    company/employee needs and should include certain components.

-   ***Commentary:*** In the EAP field, the concept of Client-Company
    Centered is a complex issue. Because there is often an overlap
    between the services purchased by the company for both itself and
    the employees there is a potential tension and conflict between some
    services. The standards and guidelines for the industry need to pay
    particular attention to this aim.

**AIM 4- EQUITABLE:**

-   ***Guiding principle for the EAP profession:*** The access and
    quality of care provided do not vary because of client or
    organizational characteristics including ethnicity, age, gender,
    religion, sexual orientation, disability, diagnosis, geographic
    location, socioeconomic status, legal status, and type of
    employment.

-   ***Examples of the types of EAP standards and guidelines that align
    with this aim:*** Evaluations reflect satisfaction with cultural
    issues. Physical facilities meet disability needs. Program
    philosophies, polices, and design support equity.

-   ***Commentary:*** At initial assessment this aim appears very
    straightforward for the EAP filed. However, it becomes more complex
    as the quality and accountability evolves. Combined with the issues
    raised in the client- centered aim, it is imperative for EAPs to
    measure and account for the potential issues that arise in this dual
    role between the client and the company.

**AIM 5- EFFICIENT:**

-   ***Guiding principle for the EAP profession:*** EAPs manage their
    human, program and physical resources in ways that minimize waste
    and optimize access to EAP services.

-   ***Summary of the types of EAP standards and guidelines that align
    with this aim:*** Efficiency relates to maximum accessibility and
    minimum waste. The correct number and kind of staff exist.
    Evaluations show positive responses and correct utilization rates.
    Counseling services are staffed in the correct ratio and are
    available when needed. Access procedures exist and include
    availability; they minimize barriers. There should be up-to-date
    information on referral resources and insurance coverage.

-   ***Commentary:*** As the reimbursement and overall expenditures for
    EAP services decline the issues of efficiency become more salient.
    While efficiency is a central aim, it will be important for EAPs to
    be careful that the quest for efficiency doesn't become a reduction
    of service or accessibility. The quest for efficiency must not occur
    at the expense of quality.

**AIM 6- TIMELY:**

-   ***Guiding principle for the EAP profession:*** EAP services are
    available promptly so that clients and work organizations are helped
    without unnecessary waiting or harmful delays.

-   ***Examples of the types of EAP standards and guidelines that align
    with this aim:*** Response to requests for services of all kinds is
    timely. Data and reports/other deliverables are timely.
    Issues/grievances are resolved in timely manner.

-   ***Commentary:*** Timeliness is a central performance measure for
    most EAP services. An area for improvement within the EAP field
    would be to standardize the measurement of timeliness and be able to
    track and compare this across services and vendors.

## CONCLUSIONS AND DIRECTIONS FOR FUTURE STUDIES

While the Quality Chasm report is a compelling critique of the
healthcare industry, it also offers an emerging clarity about a set of
priorities and a common agenda for change. Clearly, the same ideas hold
true when applied to the EAP field. Just looking at the report's Aims,
it is evident they offer great opportunities for change, for solving the
EAP industry's identity crisis, for further research, for generating a
process of continual improvement, and for creating a number of
innovative programs.

This paper is a beginning examination of a very exciting and complex set
of ideas presented in *Crossing the Quality Chasm*. Next steps should
include:

-   examining the report's ten Rules in a similar manner done with the
    Aims in this effort;

-   examining the relevance of the President's New Freedom Commission
    report to the EAP sector;

-   looking at the four areas for immediate action presented in the
    Quality Chasm report (applying evidence to the delivery of health
    care services, the use of information technology, aligning payment
    policies with quality improvement, and preparing the workforce) and
    see where they provide opportunities for the EAP field;

-   more fully developing a set of EAP strategies based on the levels of
    impact/systems described earlier in this paper; and

-   perhaps most importantly, developing a set of EAP principles,
    standards, and performance measures that reflect the ideas found in
    the Quality Chasm report.

The ideas contained in Quality Chasm report and this paper can provide a
framework for renewing the EAP profession and bridging its gap between
practices and a sound foundation. The EAP field has an essential role in
the health of America's workforce and can benefit from these guiding
principles.

# ***REFERENCES***

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