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