Quality by Design (eBook)

A Clinical Microsystems Approach

Marjorie M. Godfrey, Tina C. Foster, Julie K. Johnson, Eugene C. Nelson, Paul B. Batalden (Herausgeber)

eBook Download: EPUB

2025 | 2. Auflage
885 Seiten
Jossey-Bass (Verlag)
9781119219774 (ISBN)

Infos

The latest edition of the bestselling text on quality improvement in health care, providing powerful theoretical frameworks and principles, valuable tools and techniques, and a proven action-learning program

Now in its second edition, Quality By Design contains an evidence and practice based strategy for teaching and practicing the clinical microsystem approach across all levels of health care organizations. Overall, the microsystem approach continues to evolve and adapt to meet the changing needs of healthcare organizations. Ongoing research, the development of updated models, and innovative applications across diverse settings demonstrate the approach's potential to transform healthcare delivery and improve outcomes for patients and staff alike.

This innovative volume provides research and practical results based on the original high-performing clinical microsystems research conducted at The Dartmouth Institute for Health Policy and Clinical Practice. Quality By Design, Second Edition, advances clinical microsystem theory and practice with new material and updates:
New in the Second Edition: 

• Global Impact: The microsystem approach has gained traction internationally, with healthcare organizations and universities in various countries successfully adapting and implementing the approach in specific healthcare cultural and contextual nuances. Real-world case studies showcase the microsystem approach's success across diverse healthcare settings.
• Patient-Centered Care: Emphasis on coproduction of care, where patients and families are active partners in improvement
• Meeting Standards: Guidance on using the microsystem framework including effective meeting skills to ensure productivity and value of meetings.
• Team Coaching: Team Coaching case studies demonstrate its effectiveness in empowering frontline teams and improving their capabilities. Simultaneously, insights into multi-level leadership guide horizontal and vertical integration efforts for organizational success.
• Workforce Development and Well-being: Updated strategies for interprofessional education and development early in a career and throughout a career to learn to provide care and improve care is included
• System-Wide Improvement: New models and insights underscores the importance of integrating micro, meso, and macro systems to create a cohesive and efficient healthcare system. This involves aligning goals, processes, and communication across different levels of the organization.
• Data-Driven Decision Making: Strategies for building information-rich environments and leveraging data at all levels including key measurement and change management techniques.
• Patient Safety and Reliability: A personal case study offers a fresh perspective on error prevention and improving reliability
• Action Guide: An updated guide to accelerating improvement in clinical mesosystems.
• Remember: Successful implementation of the microsystem approach requires a long-term commitment to continuous learning, collaboration, and adaptation. By fostering a culture of improvement and empowering staff at all levels, organizations can harness the power of microsystems to achieve their quality and safety goals.

This expanded edition solidifies Quality by Design as an indispensable resource for anyone committed to transforming healthcare through the power of microsystems.

Marjorie M. Godfrey, PhD, MS, BSN, FAAN, Founding Executive Director, the Institute for Excellence in Health and Social Systems, Research Professor, Department of Nursing, University of New Hampshire. Affiliate Professor Jönköping University, Jönköping Sweden. Previously Founding Co-Director Dartmouth Institute Microsystem Academy, Geisel School of Medicine, Dartmouth College.

Tina C. Foster, MD, MPH, MSc, Professor of Obstetrics and Gynecology, Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Professor of The Dartmouth Institute, Geisel School of Medicine at Dartmouth. Previously Co-Director Dartmouth Institute Microsystem Academy, Geisel School of Medicine, Dartmouth College.

Julie K. Johnson, MSPH, PhD, Professor Department of Surgery and Center for Healthcare Studies Northwestern University

Eugene C. Nelson, DSc, MPH, Professor of Community and Family Medicine, Geisel School of Medicine at Dartmouth, and The Dartmouth Institute for Health Policy and Clinical Practice. Director of Population Health and Measurement, The Dartmouth Institute.

Paul B. Batalden, MD, Professor Emeritus, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College.

Textauszug

TABLES, FIGURES, AND EXHIBITS

Tables

• 1.1 Scope of Primary Success Characteristics and Illustrative Underlying Principles 15
• 1.2 Specific Examples of the Primary Success Characteristics 17
• 1.3 Illustrative Best Practices Used by High‐Performing Clinical Microsystems 20
• 1.4 National and International Research and Improvement Programs 23
• 3.1 Hypertension Improvement Matrix 76
• 3.2 Best Practice Improvement Toolkit for Hypertension 77
• 3.3 Summary of Changes 82
• 3.4 Improvement Training Methods 83
• 3.5 Behaviors, Actions, and Approaches that Leaders Use to “Build Knowledge” 89
• 3.6 Attributes, Concrete Steps, and Behaviors Associated with Leaders in High‐Performing Clinical Microsystems 91
• 3.7 How Leaders Review and Reflect 93
• 3.8 Needs Identified by Mesosystem Leaders 94
• 3.9 Helpful Knowledge and Skills for Clinical Mesosystem Leaders 95
• 3.10 Six Commonly Recognized Needs 95
• 3.11 Positive Work‐Life Context Statements 97
• 3.12 Supportive Information Infrastructure Questions 97
• 3.13 Factors that Influence Our Thinking 98
• 3.14 Time Estimates to do the Work 98
• 4.1 Changes Over Time 122
• 4.2 Self‐Evaluation with Coaching Interdisciplinary Professional 124
• 4.3 Four Levels of Relationships 128
• 4.4 Examples of Skills Addressed in a Personal Skills Assessment 134
• 4.5 Five themes Managers Should Include in Their Leadership and Development 136
• 5.1 PCMH Success Elements and Their Links to the 5Ps 151
• 5.2 Know the Ps for Clinical Microsystems Across the Health Continuum 158
• 5.3 Practice Core and Supporting Processes Assessment 166
• 5.4 Assessing Your Practice Discoveries and Actions: the Ps 174
• 5.5 Assessing Your Practice Discoveries and Actions: Common Oversights and Wastes 177
• 5.6 Challenges on Medical Services by Microsystem Domain 180
• 6.1 A Framework for Patient–Professional Partnership 193
• 6.2 The 5Ps Clinical Microsystem Framework Augmented with a Coproduction Lens 202
• 6.3 Change Concepts for Coproduction 207
• 7.1 Classification of Patient Safety Events 223
• 7.2 Conditions That Contribute to Errors and Adverse Events as seen through the Who Framework 224
• 7.3 Linkage Between Microsystem Characteristics and Patient Safety 239
• 8.1 Dallas OneCF Center Population Measures 259
• 8.2 Dallas OneCF Center Outcome Measures 259
• 8.3 Dallas OneCF Center Process Measures 260
• 8.4 Percentage of Health Maintenance Activities Completed (February 2016) 268
• 8.5 Percentage of Health Maintenance Activities Completed (Improvement Phase) 270
• 8.6 Tips for Developing and Sustaining an Actionable Rich Information Environment 286
• 8.7 Fundamental and Intermediate Improvement Measurement Skills Education in Dartmouth Microsystem Academy Programs 289
• 9.1 Key Constraints Creating Barriers to Quality and Safety Integration 304
• 9.2 Summary of School of Nursing Quality Improvement Task Forces and Pdsa Cycles 310
• 9.3 Summary of Patient and Team Self‐Perception 321
• 10.1 Quality Improvement Assessment (Qia) Categories 352
• 10.2 Relational Coordination Survey Dimensions 352
• 10.3 CF Ltt Llc Relational Coordination Interventions – Examples 355
• 10.4 Comparison of Two Case Studies 357
• A.1.1  The Twenty Sites Examined in the Clinical Microsystem Study 35
• A.4.1  Staff Satisfaction Survey 130
• A.4.2  Staff Personal Skills Assessment 132

Figures

• 1.1 Chain of Effect in Improving Healthcare Quality 4
• 1.2 Network of Care 5
• 1.3 Anatomy of a Clinical Microsystem 7
• 1.4 Research Design for Study of 20 Clinical Microsystems 11
• 1.5 Success Characteristics of High‐Performing Clinical Microsystems 13
• 1.6 A Model of Knowledge Creation Through Interactive Research 25
• 2.1 Success Characteristics of High‐Performing Clinical Microsystems 38
• 2.2 Map of Area Around Sheffield Uk 40
• 2.3 Team Coaching Model 41
• 2.4 The Improvement Ramp 42
• 2.5 I Dropped My Quarter 44
• 2.6 Lamppost Figure – SPC Chart of Adherence Data 45
• 2.7 Beginning the Improvement Journey: the Star Indicates the Theme of Improvement 47
• 2.8 The CF Clinic Flowchart 48
• 2.9 Cause and Effect for Patient Waiting in CF Clinic 49
• 2.10 CF Clinic Redesign Process Flowchart 49
• 2.11 SPC Chart of Waiting Times in the CF Clinic 51
• 2.12 Overview of CF Improvement Activities 52
• 2.13 Adapted COM‐B Behavior Change Model 54
• 2.14 A Model for a Microsystems Developmental Journey 57
• 2.15 Mixed Up Improvement Ramp 60
• 3.1 A View of the Multilayered Health System 72
• 3.2 Example of Local Areas of Autonomy Compared to Service Lines: Cardiovascular Care 75
• 3.3 Final Hypertension Work Flow – Primary Care 79
• 3.4 Final Hypertension Work Flow – Specialty Care 80
• 3.5 Team‐Based Care Model of Service Line Resources 81
• 3.6 Team‐Based Care Model: Horizontal Alignment Across Microsystems 82
• 3.7 Hypertension Improvement Over Time 85
• 3.8 Microsystem Preventative, Acute, Chronic, and Palliative Subpopulations 85
• 3.9 The Healthcare System as an Inverted Pyramid 87
• 4.1 Participant Confidence with Conflict Management and Relationships 118
• 4.2 Coaches‐In‐Training Confidence in Coaching Skills 119
• 4.3 Clinical Microsystem Staff Short Survey 129
• 5.1 The Original Improvement Formula 147
• 5.2 The Updated Improvement Formula 147
• 5.3 Two System Levels of Action to Plan Focused and Disciplined Improvement Strategy to Meet Pcmh Standards 153
• 5.4 Medical Home Activity Survey 154
• 5.5 Medical Home Gantt Chart 155
• 5.6 Patient Viewpoint Survey 163
• 5.7 RC Map 169
• 5.8 High‐Level View of a Primary Care Clinical Microsystem 171
• 5.9 CF Lung Transplant Mesosystem 5Ps 181
• 6.1 The Phases of Project Execution/System Development Life Cycle 195
• 6.2 Coproduction Continuum: Health Professionals and Patients 200
• 6.3 Patient–Professional Partnership along the Improvement Ramp 204
• 7.1 Haddon Matrix Analyzing an Auto Accident 226
• 7.2 Safety Matrix for Analyzing Patient Safety Event 227
• 8.1 Dartmouth Spine Center Dashboard 254
• 8.2 SRQ Dashboard for a Rheumatoid Arthritis Patient 255
• 8.3 Longitudinal Outcomes for Rheumatoid Arthritis Patients in Sweden 256
• 8.4 Dallas Onecf Center Modified Scorecard 258
• 8.5 Dummy Dashboard Structure 261
• 8.6 Dallas Onecf Center Populated Dummy Dashboard 262
• 8.7 Dallas Onecf Center Initial Dashboard 263
• 8.8 Dallas Onecf Center Spc Dashboard 264
• 8.9 Cascading Measures 265
• 8.10 Colorectal Screening Stratified Bar Chart 269
• 8.11 Depression Screening Run Chart 271
• 8.12 Clinical Value Compass 273
• 8.13 Balanced Scorecard 274
• 8.14 Basic Improvement Measurement Process 275
• 8.15 Linking Short‐ and Long‐Term Measures 278
• 8.16 Cascading Measures Across System Levels 279
• 8.17 Information Flow Systems (“Feed...

Produkt-Details

• Erscheint lt. Verlag: 13.1.2025
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Schlagworte: clinical microsystems • clinical microsystems improvement • health care administration textbook • health care improvement textbook • health care leadership • health care microsystems • health care microsystems improvement • health care quality improvement
• ISBN-13: 9781119219774 / 9781119219774