Quality By Design: A Clinical Microsystems Approach / Edition 1

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Quality by Design offers a new and innovative approach to transforming our health care system to be safe, timely, effective, efficient, equitable, and patient-centered. The authors' microsystem concepts and proven approach achieve the best patient outcomes by developing reliable, efficient, and responsive systems that have the capability of meeting the individual needs of one patient, continually improving care for the next patient, and creating a great place to work for all staff.

Quality by Design reflects the research and applied training conducted at Dartmouth Medical School under the leadership of Eugene Nelson, Paul Batalden, and Marjorie Godfrey. The book includes the research results of high-performing clinical microsystems, illustrative case studies that highlight individual clinical programs, guiding principles that are easily applied, and tools, techniques, and methods that can be adapted by clinical practices and interdisciplinary clinical teams. The authors: describe how to develop microsystems that can attain peak performance through active engagement of interdisciplinary teams in learning and applying improvement science and measurement; explore the essence of leadership for clinical Microsystems; show what mid-level leaders can do to enable peak performance at the front lines of care; outline the design and redesign of services and planning care to match patient needs with services offered; examine the issue of safety; describe the vital role of data in creating a rich and useful information environment; provide a core curriculum that can build microsystems' capability, provide excellent care, promote a positive work environment, and contribute to the largerorganization. Quality by Design offers powerful theoretical frameworks and principles, valuable tools and techniques, and an action-learning program.

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Product Details

  • ISBN-13: 9780787978983
  • Publisher: Wiley
  • Publication date: 3/16/2007
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 508
  • Sales rank: 186,852
  • Product dimensions: 7.03 (w) x 9.33 (h) x 1.04 (d)

Table of Contents

Tables, Figures, and Exhibits     xiii
Foreword   Donald M. Berwick     xix
Preface     xxiii
Acknowledgments     xxvii
Introduction     xxxi
The Editors     xxxix
The Contributors     xliii
Cases and Principles     1
Success Characteristics of High-Performing Microsystems: Learning from the Best   Eugene C. Nelson   Paul B. Batalden   Thomas P. Huber   Julie K. Johnson   Marjorie M. Godfrey   Linda A. Headrick   John H. Wasson     3
True Structure of the System, Embedded Systems, and Need to Transform Frontline Systems
The Bladyka Case
Research Design
Practical Implications
Developing High-Performing Microsystems   Eugene C. Nelson   Paul B. Batalden   William H. Edwards   Marjorie M. Godfrey   Julie K. Johnson     34
Case Study: A Decade of Progress for an Intensive Care Nursery
A Model of Development and a Curriculum to Catalyze Microsystem Growth
Leading Microsystems   Paul B. Batalden   Eugene C. Nelson   Julie K. Johnson   Marjorie M. Godfrey   Thomas P. Huber   Linda Kosnik   Kerri Ashling     51
Leader, Leadership,Leading
Recap of Methods
Three Fundamental Processes of Leading: What Clinical Microsystem Team Members Observe and Report
Leading Macrosystems and Mesosystems for Microsystem Peak Performance   Paul B. Batalden   Eugene C. Nelson   Paul B. Gardent   Marjorie M. Godfrey     69
Case Study: A True Story, with Names Changed to Protect the Innocent
Leadership Frameworks: Some of the Best Approaches
Leading Large Health Systems to Peak Performance Using Microsystem Thinking
Developing Professionals and Improving Worklife   Thomas P. Huber   Marjorie M. Godfrey   Eugene C. Nelson   Julie K. Johnson   Christine Campbell   Paul B. Batalden     106
Case Study: Staff Development at Massachusetts General Hospital Downtown Associates
Planning Patient-Centered Services   Marjorie M. Godfrey   Eugene C. Nelson   John H. Wasson   Julie K. Johnson   Paul B. Batalden     124
Planning Patient-Centered Services and the 5 P's
Case Study: Planning Services for Subpopulations of Patients to Best Provide Care for Individual Patients
A Developmental Journey: Beginning to Assess, Understand, and Improve a Clinical Microsystem
Analysis and Improvement of Processes
A Huddle in Plastic Surgery
Planning Patient-Centered Care   John H. Wasson   Marjorie M. Godfrey   Eugene C. Nelson   Julie K. Johnson   Paul B. Batalden     148
Planning Care Well: Exemplary Clinical Microsystems
Planning Care in Any Microsystem
A Low-Tech Example for Ambulatory Services: Care Vital Signs
Improving Patient Safety   Julie K. Johnson   Paul Barach   Joseph P. Cravero   George T. Blike   Marjorie M. Godfrey   Paul B. Batalden   Eugene C. Nelson     165
Microsystem Patient Safety Scenario
Case Study: Dartmouth-Hitchcock PainFree Program
Creating a Rich Information Environment   Eugene C. Nelson   Paul B. Batalden   Karen Homa   Marjorie M. Godfrey   Christine Campbell   Linda A. Headrick   Thomas P. Huber   Julie K. Johnson   John H. Wasson     178
Specialty Care: Dartmouth-Hitchcock Spine Center
Overlook Hospital Emergency Department
Intermountain Health Care Shock Trauma Intensive Care Unit
Tips and Principles to Foster a Rich Information Environment
Activating the Organization and the Dartmouth Microsystem Improvement Curriculum     197
Overview of Path Forward and Introduction to Part Two     199
Recap of Part One and Overview of Part Two
Using Real Case Studies and Practical Applications of Microsystem Thinking, Methods, and Tools
Working at All Levels of a Health System
Focusing on the Microsystem Level
Review Questions
Introduction to Microsystem Thinking     230
What Is a System in Health Care?
How Did Clinical Microsystem Knowledge Evolve?
What Is a Clinical Microsystem?
Where Do Clinical Microsystems Fit in the Health Care Delivery System?
What Does a Clinical Microsystem Look Like?
Why Focus on the Clinical Microsystem?
How Do Clinical Microsystems Link to Crossing the Quality Chasm?
What Were the Findings of the Dartmouth Clinical Microsystem Research?
What Does a Microsystem's Developmental Journey Look Like?
Case Studies
Review Questions
Between Sessions Work
Effective Meeting Skills I     243
What Is a Productive and Effective Meeting?
Why Use Meeting Skills and Roles?
What Are Effective Meeting Roles?
What Are the Phases of an Effective Meeting?
What Processes Are Evident in an Effective Meeting?
What Is the Seven-Step Meeting Process?
What Does a Meeting Agenda Template Look Like?
What Are the Ground Rules for Meetings?
What Are Some Tips for Getting Started with Productive Meetings?
How Do You Keep a Rhythm of Improvement?
Case Studies
Review Questions
Between Sessions Work
Assessing Your Microsystem with the 5 P's     258
How Does an Interdisciplinary Lead Improvement Team Begin to Assess and Improve a Clinical Microsystem?
What Does the 5 P's Framework Look Like?
What Resources Are Available to Guide the 5 P's Assessment?
What Is a Helpful Way to Introduce Your Team to the Assessment Process?
What Are the 5 P's?
What Should You Do with the Assessment Findings?
Case Studies
Review Questions
Between Sessions Work
The Model for Improvement: PDSA [leftrightarrow] SDSA     271
What Is the Model for Improvement?
Why Use the Model for Improvement?
How Does the Model Fit into the Improvement Process?
What Is the PDSA Part of the Model?
What Are the Benefits of Using PDSA?
What Is Involved in Each of the Four Steps of Plan, Do, Study, and Act?
What Is the SDSA Cycle?
What Is Involved in Each of the Four Steps of Standardize, Do, Study, and Act?
What Tools Can Assist Your PDSA Cycle [leftrightarrow] SDSA Implementation?
What Are Some Tips for Using the PDSA [leftrightarrow] SDSA Method?
Case Studies
Review Questions
Between Sessions Work
Selecting Themes for Improvement     284
What Is a Theme for Improvement?
Why Use a Theme?
What Are the Theme Selection Considerations?
What Process Can You Use to Generate Theme Ideas and Select a First Theme?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Improvement Global Aim     291
What Is a Global Aim?
Why Use a Global Aim?
How Do You Write a Global Aim?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Process Mapping     296
What Is Process Mapping?
Why Use Process Mapping?
What Are the Commonly Used Flowchart Symbols?
What Does a High-Level Flowchart Look Like?
What Does a Detailed Flowchart Look Like?
What Are Some Tips for Creating a Flowchart?
What Does a Deployment Flowchart Look Like?
What Are Some Tips for Creating a Deployment Flowchart?
Case Studies
Review Questions
Between Sessions Work
Specific Aim     308
What Is a Specific Aim?
Why Use a Specific Aim?
Where Do Specific Aims Come From?
Where Does the Specific Aim Fit in the Overall Improvement Process?
How Do You Write a Specific Aim?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Cause and Effect Diagrams     313
What Is a Cause and Effect Diagram?
Why Use a Fishbone Diagram?
What Is the Structure of a Fishbone Diagram?
What Does a Completed Fishbone Look Like?
What Are Some Tips for Creating a Fishbone Diagram?
Case Studies
Review Questions
Between Sessions Work
Effective Meeting Skills II: Brainstorming and Multi-Voting     321
What Is Brainstorming?
What Are the Benefits of Brainstorming?
What Are Some Different Types of Brainstorming?
What Are Some Tips for Conducting Brainstorming?
What Is Multi-Voting?
Do Teams Always Multi-Vote After a Brainstorming Session?
How Do You Multi-Vote?
What Does a Brainstorming Session with a Multi-Voting Outcome Look Like?
Case Studies
Review Questions
Between Sessions Work
Change Concepts     331
What Is a Change Concept?
Why Use Change Concepts?
How Can You Use Change Concepts in a Process?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Measurement and Monitoring     339
What Are Measures, What Makes Measures Good, and How Do They Relate to Aims?
What Is a Run Chart?
What Are the Benefits of Using a Run Chart?
How Do Run Charts Fit in the Overall Improvement Process?
What Do Run Charts Tell You About Your Performance Level and Variation?
What Are Special Cause and Common Cause Variation?
How Do You Make a Run Chart?
How Do You Interpret Run Chart Results?
What Is a Control Chart?
What Is the Theory Behind Control Charts?
What Are the Benefits of Using a Control Chart Instead of a Run Chart?
What Are the Different Kinds of Control Charts?
What Is an XmR Control Chart?
How Do You Interpret Control Chart Results?
When Do You Recalculate Control Chart Values?
What Are Some Tips for Using Run Charts and Control Charts?
Case Studies
Review Questions
Between Sessions Work
Action Plans and Gantt Charts     362
What Is an Action Plan?
What Is a Gantt Chart?
Why Use Action Plans and Gantt Charts?
How Do You Write an Action Plan?
How Do You Create a Gantt Chart?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Follow Through on Improvement: Storyboards, Data Walls, and Playbooks     369
What Is the Importance of Follow Through?
What Can You Do to Follow Through?
What Are the Fundamentals of Improvement?
What Is a Data Wall?
What Is a Playbook?
How Is the Playbook Used?
How Do You Create a Playbook?
How Do You Maintain Your Playbook?
What Is a Storyboard?
How Do You Make a Storyboard?
Case Studies
Review Questions
Between Sessions Work
Conclusion: Continuing on the Path to Excellence     380
Looking Back
Looking Forward and an Invitation: Make It Personal and Make It Happen
Primary Care Workbook     385
Name Index     433
Subject Index     437
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