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Tunnels represent a significant financial investment with challenging design, construction, and operational issues. Tunnels that are not adequately maintained usually require more costly and extensive repairs. To help safeguard tunnel users and to ensure reliable levels of service, the FHWA developed the National Tunnel Inspection Standards (NTIS), the Tunnel Operations Maintenance Inspection and Evaluation (TOMIE) Manual, and the Specifications for National Tunnel Inventory (SNTI). In accordance with the NTIS, this Manual describes methods for improving the safety and performance of roadway tunnel operation, maintenance, inspection, and evaluation programs.
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.