book

Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence, Second Edition

Name: Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence, Second Edition
ISBN: 9780470385340

by Eugene C. Nelson, Paul B. Batalden, Marjorie M. Godfrey, Joel S. Lazar

March 2011

Intermediate to advanced

374 pages

11h 10m

English

Jossey-Bass

Read now

Unlock full access

Copyright
FOREWORD
References
PREFACE
IMPROVEMENT AT THE FRONT LINE OF CAREThe Dartmouth Institute's Clinical Microsystems CourseOrganization of the Microsystems CourseThe Clinical Microsystem ModelOrganization of This BookAdditional Features and Online Resources
1. INTRODUCING CLINICAL MICROSYSTEMS
1.1. LEARNING OBJECTIVES1.2. MICROSYSTEMS IN HEALTH CARE1.2.1. The Functional Unit in Health Care1.3. A BROADER VIEW OF SYSTEMS AND MICROSYSTEMS1.3.1. Systems Dynamics and Embedded Systems1.3.2. The Institute of Medicine's Chain of Effect in Health Care1.3.3. Horizontal and Vertical Levels of the Health Care System1.3.4. Microsystems and Their External Context1.4. RESEARCH ON MICROSYSTEMS IN HEALTH CARE1.4.1. Microsystem Research1.4.2. Microsystem in Macrosystem Research1.4.3. Emerging Microsystem Research in Sweden and the Future1.4.4. Organizing for Quality1.5. THREE CONCEPTUAL IMPERATIVES IN THE WORK OF VALUE IMPROVEMENT1.5.1.1.5.1.1. Imperative Number 1: Engage Everyone in Value Improvement1.5.1.2. Imperative Number 2: Work the Improvement Equation1.5.1.3. Imperative Number 3: Frame Problems and Practice Solutions as Simple, Complicated, or Complex1.6. CONCLUSION1.7. SUMMARY1.8. KEY TERMS1.9. REVIEW QUESTIONS1.10. DISCUSSION QUESTIONS1.11. REFERENCES
Chapter One ACTION GUIDE
1.12. INTRODUCTION TO THE 5PS1.13. THE CLINICAL MICROSYSTEM PROCESS AND STRUCTURE OF THE 5PS MODEL1.14. EXTERNAL MAPPING TOOL1.15. MICROSYSTEM ASSESSMENT TOOL (MAT)1.15.1. Description and Use of MAT1.15.2. Guidelines for Scoring with MAT1.15.3. Interpretation of Scores
2. PARTNERING WITH PATIENTS TO DESIGN AND IMPROVE CARE
2.1. LEARNING OBJECTIVES2.2. THE AIM OF HEALTH CARE AND THE NEED TO PARTNER WITH PATIENTS2.3. CONCEPTUAL FRAMEWORKS FOR PARTNERING WITH PATIENTS2.3.1. Core Concepts2.3.2. Target Diagram and Clinical Microsystem Model2.3.3. Kano Model of Satisfaction with Services2.3.4. Deming Model for Organizing Services as a System of Production2.3.5. Wagner's Chronic Care Model and Lorig's Self-Management Model2.3.6. Amy's Experience in Clinical Microsystems2.3.6.1. Reflections on Amy's experience2.4. TACTICS FOR PARTNERING WITH PATIENTS2.4.1. Feed Forward Health Status Assessment2.4.2. Motivational Interviewing, Patient Contracting, and Goal Setting2.4.3. Shared Decision Making and Shared Medical Appointments2.4.4. Health Coaching and Information Prescriptions2.5. PATIENTS AS INFORMANTS AND ADVISORS2.5.1. Using Direct Observations to Improve Care2.5.2. Interviews and Surveys2.5.3. Value Stream Mapping2.5.4. Patients and Families as Committee Members and Advisors2.6. CONCLUSION2.7. SUMMARY2.8. KEY TERMS2.9. REVIEW QUESTIONS2.10. DISCUSSION QUESTIONS2.11. REFERENCES
Chapter Two ACTION GUIDE
2.12. GAINING CUSTOMER KNOWLEDGE2.12.1. Observational Skills and Ethnography2.12.2. Tips for Writing Survey Items2.12.3. Different Types of Survey Questions2.12.3.1. Ratings2.12.3.2. Opinions2.12.3.3. Reports2.12.3.4. Verbatim2.12.4. Steps for Conducting a Written Survey2.12.4.1. Structure of a Written Survey2.13. INSTITUTE FOR PATIENT AND FAMILY-CENTERED CARE MATRIX2.14. VALUE STREAM MAPPING2.15. DEFINITIONS OF SELECTED VALUE STREAM MAPPING TERMS
3. IMPROVING SAFETY AND ANTICIPATING HAZARDS IN CLINICAL MICROSYSTEMS
3.1. LEARNING OBJECTIVES3.2. CASE STUDY OF ORGANIZATIONAL FACTORS TO PROMOTE A CULTURE OF SAFETY3.2.1. Prevention of Nosocomial Infections3.3. DISCUSSION3.4. DEFINITIONS3.5. IDENTIFICATION OF MEDICAL ERRORS AND ADVERSE EVENTS3.6. FREQUENCY OF ADVERSE EVENTS AND MEDICAL ERRORS3.6.1. Causation of Medical Errors3.6.2. The Swiss Cheese Model3.6.3. Diagnostic Errors3.6.4. Prevention of Medical Errors to Ensure Patient Safety3.6.5. Proactive Identification and Mitigation of Error Risks3.6.6. Implementation and Monitoring of Safety Practices3.6.7. Learning from Errors3.6.7.1. Work Conditions3.6.7.2. Human Conditions3.6.7.3. Organizational Conditions3.6.8. Valuing a Culture of Safety3.6.9. Responding to Medical Errors3.6.10. Communicating with the Patient and the Patient's Family After an Error3.6.11. Care of Involved Health Professionals3.7. CONCLUSION3.8. SUMMARY3.9. KEY TERMS3.10. REVIEW QUESTIONS3.11. DISCUSSION QUESTIONS3.12. REFERENCES
Chapter Three ACTION GUIDE
3.13. 5S METHOD3.13.1. Sort/Seiri (Organization)3.13.2. Straighten/Seiton (Orderliness)3.13.3. Shine/Seiso (Cleanliness)3.13.4. Standardize/Seiketsu (Adherence)3.13.5. Sustain/Shitsuke (Self-Discipline)3.14. CHECKLISTS3.14.1. How to Make a Checklist3.15. FAILURE MODE AND EFFECTS ANALYSIS3.15.1. How to Conduct the FMEA Process3.16. REHEARSALS OR SIMULATIONS3.17. DESIGNING PATIENT SAFETY INTO THE MICROSYSTEM3.17.1.3.17.1.1. Background3.18. THE LINK BETWEEN SAFETY, THE MICROSYSTEM, AND MINDFULNESS3.18.1. Principle 1. Humans Are Error-Prone by Nature and so Errors Will Occur3.18.2. Principle 2. The Microsystem Is the Unit of Analysis and Training3.18.3. Principle 3. Design Systems to Identify, Prevent, Absorb, and Mitigate Errors3.18.4. Principle 4. Create a Culture of Safety3.18.5. Principle 5. Talk to and Listen to Patients3.18.6. Principle 6. Integrate Practices from Human Factors Engineering into Microsystem Functioning3.19. CONCLUSION3.20. REFERENCES
4. USING MEASUREMENT TO IMPROVE HEALTH CARE VALUE
4.1. LEARNING OBJECTIVES4.2. MEASURING WHAT MATTERS AT ALL LEVELS OF THE SYSTEM4.3. TIPS AND PRINCIPLES TO FOSTER A RICH INFORMATION ENVIRONMENT4.3.1. Principle 1: Design It—Provide Access to a Rich Information Environment4.3.2. Principle 2: Connect with It—Use Information to Connect Patients to Staff and Staff to Staff4.3.3. Principle 3: Measure It—Develop Performance Goals and Linked Measures That Reflect Primary Values and Core Competencies Essential for Providing Needed Patient Services4.3.4. Principle 4: Use It for Betterment—Measure Processes and Outcomes, Collect Feedback Data, and Redesign Continuously Based on Data4.4. DESIGNING INFORMATION FLOW TO SUPPORT HIGH-VALUE CARE4.4.1. Framework 1: Feed Forward and Feedback4.4.2. Framework 2: Patient Value Compass4.4.3. Framework 3: Balanced Scorecard—Can We Use Data to Measure and Improve?4.4.4. Comparing the Compass and the Scorecard4.4.5. The Dashboard Metaphor4.4.6. Using the Cascades Metaphor to Measure at Different Levels of a System4.4.6.1. Measure What Matters Worksheet4.5. CONCLUSION4.6. SUMMARY4.7. KEY TERMS4.8. REVIEW QUESTIONS4.9. DISCUSSION QUESTIONS4.10. REFERENCES

Chapter Four ACTION GUIDE
4.11. PATIENT VALUE COMPASS4.12. BALANCED SCORECARD4.13. MEASURE WHAT MATTERS WORKSHEET4.14. EXAMPLES OF DATA WALLS4.15. REFERENCES
5. STARTING THE PATIENT'S CARE IN CLINICAL MICROSYSTEMS
5.1. LEARNING OBJECTIVES5.2. THE ENTRY FUNCTIONS OF CLINICAL MICROSYSTEMS5.2.1. Access and Handoffs5.2.1.1. Access to Care and Services5.2.1.2. Systematically Improving Access to Care5.2.1.3. Methods to Increase Access and Improve Flow5.2.1.4. Evaluating Successful Access to Care5.2.2. Outpatient5.2.3. Inpatient5.2.4. Transitions and Handoffs5.2.4.1. Principles of Effective Transitions and Handoffs5.2.4.2. Methods5.2.4.3. Evaluating Successful Care Transitions5.2.5. Direct Assessment and Monitoring of Transition Metrics5.2.6. Indirect Assessment and Monitoring of Downstream Outcomes5.2.7. Orienting Patients to Navigate Care5.2.7.1. Principles for Orienting Patients to Microsystems5.2.7.2. Methods of Improving the Orientation Process5.2.7.3. Evaluating Success of the Orientation Process5.2.8. Initial Assessment and Plan of Care5.2.8.1. Characteristics of Effective Care Plans5.2.8.2. The Wagner Care Model5.2.8.3. Evaluating Care Plan Success5.3. CONCLUSION5.4. SUMMARY5.5. KEY TERMS5.6. REVIEW QUESTIONS5.7. DISCUSSION QUESTIONS5.8. REFERENCES
Chapter Five ACTION GUIDE
5.9. PROCESS MAPPING WITH FLOWCHARTS5.9.1. Deployment Charts5.10. ACCESS MEASURES AND TOOLS5.11. CARE VITAL SIGNS5.12. REFERENCE
6. DESIGNING PREVENTIVE CARE TO IMPROVE HEALTH
6.1. LEARNING OBJECTIVES6.2. THE WORK OF PREVENTIVE HEALTH CARE6.3. AN ACTION-BASED TAXONOMY OF PREVENTIVE HEALTH SERVICES6.3.1. Principles for Designing and Improving Preventive Health Care in Clinical Microsystems6.3.2. The Clinical Improvement Equation6.3.3. Specific Questions to Support the Design and Improvement of Preventive Care6.3.3.1. In Our Microsystem, What Diseases or Hazards Pose a Risk to Our Patients, and What Evidence-Based Interventions Can Mitigate These Risks?6.3.3.2. In Our Microsystem, What Patient and Practice Characteristics Support or Impede Risk Reduction?6.3.3.3. In Our Microsystem, How do We Maximize the Likelihood That Risk-Reducing Interventions Are Performed ?6.3.3.4. In Our Microsystem, How Do We Monitor Our Performance?6.4. CONCLUSION6.5. SUMMARY6.6. KEY TERMS6.7. REVIEW QUESTIONS6.8. DISCUSSION QUESTIONS6.9. REFERENCES
Chapter Six ACTION GUIDE
6.10. RADIOLOGY MICROSYSTEM PREVENTIVE ACTIVITY OF MAMMOGRAPHY AND VAP BUNDLES IN CRITICAL CARE
7. PLANNING FOR RESPONSIVE AND RELIABLE ACUTE CARE
7.1. LEARNING OBJECTIVES7.2. ANTICIPATING THE NEEDS OF ACUTELY ILL PATIENTS7.3. DEFINING ACUTE CARE NEEDS OF PATIENTS AND FAMILIES7.4. AN OVERVIEW OF DESIGN REQUIREMENTS FOR ACUTE CARE7.4.1. Time Is in the Foreground7.4.2. Evidence-Based Algorithms and Structured Decision Making7.4.3. Well-Defined (but Flexible) Roles Within the Clinical Microsystem7.4.4. Unique Role of Patient and Family7.4.5. Planning for the Expected Surprise7.5. ADVANCED ACCESS AND EFFECTIVE CARE TRANSITIONS7.5.1. Effective Care Transitions7.6. CONCLUSION7.7. SUMMARY7.8. KEY TERMS7.9. REVIEW QUESTIONS7.10. DISCUSSION QUESTIONS7.11. REFERENCES
Chapter Seven ACTION GUIDE
8. ENGAGING COMPLEXITY IN CHRONIC ILLNESS CARE
8.1. LEARNING OBJECTIVES8.2. AN INVITATION TO COMPLEXITY8.3. THE EXPERIENCE OF CHRONIC ILLNESS8.4. THE BURDEN OF CHRONIC ILLNESS8.5. THE GOALS OF CHRONIC ILLNESS CARE8.6. CLINICAL COMPLEXITY IN CHRONIC ILLNESS CARE8.7. DESIGNING FOR COMPLEXITY THROUGH ALIGNMENT OF PROBLEMS AND PRACTICE SOLUTIONS8.8. THE NATURE OF COMPLEX ADAPTIVE SYSTEMS8.9. THE CHRONIC CARE MODEL8.9.1. Self-Management Support8.9.2. Delivery System Design8.9.3. Decision Support8.9.4. Clinical Information Systems8.9.4.1. Is the Chronic Care Model Effective?8.10. CARE COORDINATON AND TRANSITIONS8.11. PATIENT SELF-MANAGEMENT8.12. CONCLUSION8.13. SUMMARY8.14. KEY TERMS8.15. REVIEW QUESTIONS8.16. DISCUSSION QUESTIONS8.17. REFERENCES
Chapter Eight ACTION GUIDE
8.18. STAR GENERATIVE RELATIONSHIPS8.19. REFERENCE
9. SUPPORTING PATIENTS AND FAMILIES THROUGH PALLIATIVE CARE
9.1. LEARNING OBJECTIVES9.2. THE NEED FOR PALLIATIVE CARE IN MODERN AMERICA9.3. END-OF-LIFE EXPERIENCE YESTERDAY AND TODAY9.4. PRINCIPLES OF PALLIATIVE CARE9.5. REDUCING VARIATION IN END-OF-LIFE CARE9.6. CORE PROCESSES IN PALLIATIVE CARE9.6.1. Assessing the Full Health Status and Well-Being of Patient and Family9.6.2. Planning for the Patient and Family9.6.3. Providing Services to Patient and Family9.7. CARE COORDINATION NEAR THE END OF LIFE9.8. FORMAL PALLIATIVE CARE AND HOSPICE PROGRAMS9.9. PLANNING FOR BOTH LIFE AND DEATH WITH ADVANCE DIRECTIVES9.10. CONCLUSION9.11. SUMMARY9.12. KEY TERMS9.13. REVIEW QUESTIONS9.14. DISCUSSION QUESTIONS9.15. REFERENCES
Chapter Nine ACTION GUIDE
9.16. MENTAL MODELS9.17. USING THE LADDER OF INFERENCE TO EXPLORE MENTAL MODELS9.18. REFERENCE
10. DESIGNING HEALTH SYSTEMS TO IMPROVE VALUE
10.1. LEARNING OBJECTIVES10.2. FROM PARTS TO WHOLE10.3. NEW VISION OF INTEGRATED SYSTEMS TO PRODUCE HIGH VALUE10.3.1. Create Value-Based Competition10.3.2. Learn from Toyota to Relentlessly Reduce Waste and Continuously Add Value10.3.3. Christensen's Use of Different Business Models to Improve Health Care Value10.3.4. Fisher's Work to Create Accountable Care Organizations that Provide High-Value Care10.3.5. Learn What We Need to Know10.3.5.1. Lean Theory, Principles, and Methods10.3.5.2. Safety Sciences and Human Factors Design10.3.5.3. Performance Measurement Principles and Methods10.3.5.4. Patient-Centered Design and Experience-Based Co-Design10.4. THE EXECUTION TRIANGLE10.5. LEADING CHANGE AT ALL LEVELS10.5.1. The Process of Leading10.6. CHANGING LOCAL CULTURE10.6.1.10.6.1.1. Edgar Schein's View on Changing Organizational Culture10.6.1.2. Bate's Work on Organizing for Transformative Change in Health Care10.7. THE PATH FORWARD FOR MAKING HIGH-VALUE HEALTH SYSTEMS10.7.1. What We Need to Do10.8. SUMMARY10.9. KEY TERMS10.10. REVIEW QUESTIONS10.11. DISCUSSION QUESTIONS10.12. REFERENCES
Chapter Ten ACTION GUIDE
10.13. MICRO-, MESO-, AND MACROSYSTEM MATRIX

Overview

Value by Design is a practical guide for real-world improvement in clinical microsystems. Clinical microsystem theory, as implemented by the Institute for Healthcare Improvement and health care organizations nationally and internationally, is the foundation of high-performing front line health care teams who achieve exceptional quality and value. These authors combine theory and principles to create a strategic framework and field-tested tools to assess and improve systems of care. Their approach links patients, families, health care professionals and strategic organizational goals at all levels of the organization: micro, meso and macrosystem levels to achieve the ultimate quality and value a health care system is capable of offering

Become an O’Reilly member and get unlimited access to this title plus top books and audiobooks from O’Reilly and nearly 200 top publishers, thousands of courses curated by job role, 150+ live events each month,
and much more.

Read now

Unlock full access

More than 5,000 organizations count on O’Reilly

O’Reilly covers everything we've got, with content to help us build a world-class technology community, upgrade the capabilities and competencies of our teams, and improve overall team performance as well as their engagement.

Julian F.

Head of Cybersecurity

I wanted to learn C and C++, but it didn't click for me until I picked up an O'Reilly book. When I went on the O’Reilly platform, I was astonished to find all the books there, plus live events and sandboxes so you could play around with the technology.

Addison B.

Field Engineer

I’ve been on the O’Reilly platform for more than eight years. I use a couple of learning platforms, but I'm on O'Reilly more than anybody else. When you're there, you start learning. I'm never disappointed.

Amir M.

Data Platform Tech Lead

I'm always learning. So when I got on to O'Reilly, I was like a kid in a candy store. There are playlists. There are answers. There's on-demand training. It's worth its weight in gold, in terms of what it allows me to do.

Mark W.

Embedded Software Engineer

The Human Factor in AI-Based Decision-Making

Publisher Resources

ISBN: 9780470385340

Cloud Computing

Data Engineering

Data Science

AI & ML

Programming Languages

Software Architecture

IT/Ops

Security

Design

Business

Soft Skills