Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence / Edition 1

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Overview

The clinical microsystems model is the approach for quality improvement in health care, endorsed by the American Hospital Association and the Joint Commission on Accreditation of Healthcare Organizations. Written by three leading experts in clinical quality improvement-authors of the bestselling Quality by Design-The Clinical Improvement Guide combines theory and principles for assessing and improving front-line clinical units with field-tested and refined practical tools to form a comprehensive approach to clinical improvement, assessment, and measurement of processes, outcomes, and performance for all the settings in which health services are delivered.

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Product Details

  • ISBN-13: 9780470385340
  • Publisher: Wiley
  • Publication date: 3/8/2011
  • Edition number: 1
  • Pages: 384
  • Sales rank: 239,373
  • Product dimensions: 7.90 (w) x 9.90 (h) x 0.70 (d)

Meet the Author

Eugene C. Nelson, DSc, MPH, is director of Population Health andMeasurement for the Dartmouth-Hitchcock Medical Center andprofessor of Community and Family Medicine at Dartmouth MedicalSchool and the Dartmouth Institute for Health Policy and ClinicalPractice. He is the recipient of the Joint Commission onAccreditation of Healthcare Organizations' Ernest A. Codman awardfor his work on outcomes measurement in health care.

Paul B. Batalden, MD, is professor of Pediatrics and ofCommunity and Family Medicine at Dartmouth Medical School. He isthe associate director of the Dartmouth-Hitchcock LeadershipPreventive Medicine Residency, and teaches at the DartmouthInstitute for Health Policy and Clinical Practice, the Institutefor Healthcare Improvement and in the Jönköping Academyfor the Improvement of Health and Welfare in Sweden.

Marjorie M. Godfrey, MS, RN, is codirector of the MicrosystemAcademy, instructor for the Dartmouth Institute for Health Policyand Clinical Practice, Dartmouth Medical School, and a recognizednational and international leader in health care improvement withinterdisciplinary professionals.

Joel S. Lazar, MD, MPH, is assistant professor of Community andFamily Medicine at the Dartmouth Institute for Health Policy andClinical Practice and section chief and medical director of FamilyMedicine at Dartmouth-Hitchcock Medical Center, where he alsoserves as director of quality improvement.

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Table of Contents

Figures and Tables.

Foreword (Elliott Fisher).

Preface: Improvement at the Front Line of Care.

Acknowledgments.

The Editors.

The Contributors.

1: Introducing Clinical Microsystems.

Learning Objectives.

Microsystems in Health Care.

A Broader View of Systems and Microsystems.

Research on Microsystems in Health Care.

Three Conceptual Imperatives in the Work of ValueImprovement.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter One Action Guide.

Introduction to the 5Ps.

The Clinical Microsystem Process and Structure of the 5PsModel.

External Mapping Tool.

Microsystem Assessment Tool (MAT).

2: Partnering with Patients to Design and ImproveCare.

Learning Objectives.

The Aim of Health Care and the Need to Partner withPatients.

Conceptual Frameworks for Partnering with Patients.

Tactics for Partnering with Patients.

Patients as informants and Advisors.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Two Action Guide.

Institute for Family-Centered Care Matrix.

Value Stream Mapping.

Definitions of Selected Value Stream Mapping Terms.

3: Improving Safety and Anticipating Hazards in ClinicalMicrosystems.

Learning Objectives.

Organizational Factors to Promote A Culture of Safety (WHO).

Discussion.

Definitions.

Identification of Medical Errors and Adverse Events.

Frequency of Adverse Events and Medical Errors.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Topics.

References.

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Chapter Three Action Guide.

5s Method.

Checklists.

Failure Mode and Effects Analysis.

Rehearsals or Simulations.

Mindfulness.

The Link Between Safety and the Microsystem.

Conclusion.

References.

4: Using Measurement to Improve Health Care Value.

Learning Objectives.

Measuring What Matters at All Levels of the System.

Tips and Principles to Foster a Rich informationEnvironment.

Designing information Flow to Support High-Value Care.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Four Action Guide.

Patient Value Compass.

Balanced Scorecard.

Measure What Matters Worksheet.

Examples of Data Walls.

5: Starting the Patient's Care in ClinicalMicrosystems.

Learning Objectives.

The Entry Functions of Clinical Microsystems.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Five Action Guide.

Process Mapping with Flowcharts.

Access Measures and Tools.

C.A.R.E. Vital Signs.

Reference.

6: Designing Preventive Care to Improve Health.

Learning Objectives.

The Work of Preventive Health Care.

An Action-Based Taxonomy of Preventive Health Services.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Six Action Guide.

Radiology Microsystem Preventive Activity of Mammography.

7: Planning for Responsive and Reliable Acute Care.

Learning Objectives.

Anticipating the Needs of Acutely Ill Patients.

Defining Acute Care Needs of Patients and Families.

An Overview of Design Requirements for Acute Care.

Advanced Access and Effective Care Transitions

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Seven Action Guide.

8: Engaging Complexity in Chronic Illness Care.

Learning Objectives.

An Invitation to Complexity.

The Experience of Chronic Illness.

The Burden of Chronic Illness.

The Goals of Chronic Illness Care.

Clinical Complexity in Chronic Illness Care.

Designing for Complexity Through Alignment of Problems andPractice Solutions.

The Nature of Complex Adaptive Systems.

The Chronic Care Model.

Care Coordinaton and Transitions.

Patient Self-Management.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Eight Action Guide.

Star Generative Relationships.

Reference.

9: Supporting Patients and Families Through PalliativeCare.

Learning Objectives.

The Need for Palliative Care in Modern America.

End-of-Life Experience Yesterday and Today.

Principles of Palliative Care.

Reducing Variation in End-of-Life Care.

Core Processes in Palliative Care.

Care Coordination Near the End of Life.

Formal Palliative Care and Hospice Programs.

Planning for Both Life and Death with Advance Directives.

Conclusion.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Nine Action Guide.

Mental Models.

Using the Ladder of Inference to Explore Mental Models.

Reference.

10: Designing Health Systems to Improve Value.

Learning Objectives.

From Parts to Whole.

New Vision of Integrated Systems to Produce High Value.

The Execution Triangle.

Leading Change at All Levels.

Changing Local Culture.

The Path Forward for Making High-Value Health Systems.

Summary.

Key Terms.

Review Questions.

Discussion Questions.

References.

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Chapter Ten Action Guide.

Micro-, Meso-, and Macrosystem Matrix.

Name Index.

Subject Index.

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