Book description
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
Table of contents
- Copyright
- FOREWORD
- PREFACE
-
1. INTRODUCING CLINICAL MICROSYSTEMS
- 1.1. LEARNING OBJECTIVES
- 1.2. MICROSYSTEMS IN HEALTH CARE
- 1.3. A BROADER VIEW OF SYSTEMS AND MICROSYSTEMS
- 1.4. RESEARCH ON MICROSYSTEMS IN HEALTH CARE
- 1.5. THREE CONCEPTUAL IMPERATIVES IN THE WORK OF VALUE IMPROVEMENT
- 1.6. CONCLUSION
- 1.7. SUMMARY
- 1.8. KEY TERMS
- 1.9. REVIEW QUESTIONS
- 1.10. DISCUSSION QUESTIONS
- 1.11. REFERENCES
- Chapter One ACTION GUIDE
-
2. PARTNERING WITH PATIENTS TO DESIGN AND IMPROVE CARE
- 2.1. LEARNING OBJECTIVES
- 2.2. THE AIM OF HEALTH CARE AND THE NEED TO PARTNER WITH PATIENTS
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2.3. CONCEPTUAL FRAMEWORKS FOR PARTNERING WITH PATIENTS
- 2.3.1. Core Concepts
- 2.3.2. Target Diagram and Clinical Microsystem Model
- 2.3.3. Kano Model of Satisfaction with Services
- 2.3.4. Deming Model for Organizing Services as a System of Production
- 2.3.5. Wagner's Chronic Care Model and Lorig's Self-Management Model
- 2.3.6. Amy's Experience in Clinical Microsystems
- 2.4. TACTICS FOR PARTNERING WITH PATIENTS
- 2.5. PATIENTS AS INFORMANTS AND ADVISORS
- 2.6. CONCLUSION
- 2.7. SUMMARY
- 2.8. KEY TERMS
- 2.9. REVIEW QUESTIONS
- 2.10. DISCUSSION QUESTIONS
- 2.11. REFERENCES
- Chapter Two ACTION GUIDE
-
3. IMPROVING SAFETY AND ANTICIPATING HAZARDS IN CLINICAL MICROSYSTEMS
- 3.1. LEARNING OBJECTIVES
- 3.2. CASE STUDY OF ORGANIZATIONAL FACTORS TO PROMOTE A CULTURE OF SAFETY
- 3.3. DISCUSSION
- 3.4. DEFINITIONS
- 3.5. IDENTIFICATION OF MEDICAL ERRORS AND ADVERSE EVENTS
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3.6. FREQUENCY OF ADVERSE EVENTS AND MEDICAL ERRORS
- 3.6.1. Causation of Medical Errors
- 3.6.2. The Swiss Cheese Model
- 3.6.3. Diagnostic Errors
- 3.6.4. Prevention of Medical Errors to Ensure Patient Safety
- 3.6.5. Proactive Identification and Mitigation of Error Risks
- 3.6.6. Implementation and Monitoring of Safety Practices
- 3.6.7. Learning from Errors
- 3.6.8. Valuing a Culture of Safety
- 3.6.9. Responding to Medical Errors
- 3.6.10. Communicating with the Patient and the Patient's Family After an Error
- 3.6.11. Care of Involved Health Professionals
- 3.7. CONCLUSION
- 3.8. SUMMARY
- 3.9. KEY TERMS
- 3.10. REVIEW QUESTIONS
- 3.11. DISCUSSION QUESTIONS
- 3.12. REFERENCES
-
Chapter Three ACTION GUIDE
- 3.13. 5S METHOD
- 3.14. CHECKLISTS
- 3.15. FAILURE MODE AND EFFECTS ANALYSIS
- 3.16. REHEARSALS OR SIMULATIONS
- 3.17. DESIGNING PATIENT SAFETY INTO THE MICROSYSTEM
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3.18. THE LINK BETWEEN SAFETY, THE MICROSYSTEM, AND MINDFULNESS
- 3.18.1. Principle 1. Humans Are Error-Prone by Nature and so Errors Will Occur
- 3.18.2. Principle 2. The Microsystem Is the Unit of Analysis and Training
- 3.18.3. Principle 3. Design Systems to Identify, Prevent, Absorb, and Mitigate Errors
- 3.18.4. Principle 4. Create a Culture of Safety
- 3.18.5. Principle 5. Talk to and Listen to Patients
- 3.18.6. Principle 6. Integrate Practices from Human Factors Engineering into Microsystem Functioning
- 3.19. CONCLUSION
- 3.20. REFERENCES
-
4. USING MEASUREMENT TO IMPROVE HEALTH CARE VALUE
- 4.1. LEARNING OBJECTIVES
- 4.2. MEASURING WHAT MATTERS AT ALL LEVELS OF THE SYSTEM
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4.3. TIPS AND PRINCIPLES TO FOSTER A RICH INFORMATION ENVIRONMENT
- 4.3.1. Principle 1: Design It—Provide Access to a Rich Information Environment
- 4.3.2. Principle 2: Connect with It—Use Information to Connect Patients to Staff and Staff to Staff
- 4.3.3. Principle 3: Measure It—Develop Performance Goals and Linked Measures That Reflect Primary Values and Core Competencies Essential for Providing Needed Patient Services
- 4.3.4. Principle 4: Use It for Betterment—Measure Processes and Outcomes, Collect Feedback Data, and Redesign Continuously Based on Data
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4.4. DESIGNING INFORMATION FLOW TO SUPPORT HIGH-VALUE CARE
- 4.4.1. Framework 1: Feed Forward and Feedback
- 4.4.2. Framework 2: Patient Value Compass
- 4.4.3. Framework 3: Balanced Scorecard—Can We Use Data to Measure and Improve?
- 4.4.4. Comparing the Compass and the Scorecard
- 4.4.5. The Dashboard Metaphor
- 4.4.6. Using the Cascades Metaphor to Measure at Different Levels of a System
- 4.5. CONCLUSION
- 4.6. SUMMARY
- 4.7. KEY TERMS
- 4.8. REVIEW QUESTIONS
- 4.9. DISCUSSION QUESTIONS
- 4.10. REFERENCES
- Chapter Four ACTION GUIDE
-
5. STARTING THE PATIENT'S CARE IN CLINICAL MICROSYSTEMS
- 5.1. LEARNING OBJECTIVES
-
5.2. THE ENTRY FUNCTIONS OF CLINICAL MICROSYSTEMS
- 5.2.1. Access and Handoffs
- 5.2.2. Outpatient
- 5.2.3. Inpatient
- 5.2.4. Transitions and Handoffs
- 5.2.5. Direct Assessment and Monitoring of Transition Metrics
- 5.2.6. Indirect Assessment and Monitoring of Downstream Outcomes
- 5.2.7. Orienting Patients to Navigate Care
- 5.2.8. Initial Assessment and Plan of Care
- 5.3. CONCLUSION
- 5.4. SUMMARY
- 5.5. KEY TERMS
- 5.6. REVIEW QUESTIONS
- 5.7. DISCUSSION QUESTIONS
- 5.8. REFERENCES
- Chapter Five ACTION GUIDE
-
6. DESIGNING PREVENTIVE CARE TO IMPROVE HEALTH
- 6.1. LEARNING OBJECTIVES
- 6.2. THE WORK OF PREVENTIVE HEALTH CARE
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6.3. AN ACTION-BASED TAXONOMY OF PREVENTIVE HEALTH SERVICES
- 6.3.1. Principles for Designing and Improving Preventive Health Care in Clinical Microsystems
- 6.3.2. The Clinical Improvement Equation
-
6.3.3. Specific Questions to Support the Design and Improvement of Preventive Care
- 6.3.3.1. 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. CONCLUSION
- 6.5. SUMMARY
- 6.6. KEY TERMS
- 6.7. REVIEW QUESTIONS
- 6.8. DISCUSSION QUESTIONS
- 6.9. REFERENCES
- Chapter Six ACTION GUIDE
-
7. PLANNING FOR RESPONSIVE AND RELIABLE ACUTE CARE
- 7.1. LEARNING OBJECTIVES
- 7.2. ANTICIPATING THE NEEDS OF ACUTELY ILL PATIENTS
- 7.3. DEFINING ACUTE CARE NEEDS OF PATIENTS AND FAMILIES
- 7.4. AN OVERVIEW OF DESIGN REQUIREMENTS FOR ACUTE CARE
- 7.5. ADVANCED ACCESS AND EFFECTIVE CARE TRANSITIONS
- 7.6. CONCLUSION
- 7.7. SUMMARY
- 7.8. KEY TERMS
- 7.9. REVIEW QUESTIONS
- 7.10. DISCUSSION QUESTIONS
- 7.11. REFERENCES
- Chapter Seven ACTION GUIDE
-
8. ENGAGING COMPLEXITY IN CHRONIC ILLNESS CARE
- 8.1. LEARNING OBJECTIVES
- 8.2. AN INVITATION TO COMPLEXITY
- 8.3. THE EXPERIENCE OF CHRONIC ILLNESS
- 8.4. THE BURDEN OF CHRONIC ILLNESS
- 8.5. THE GOALS OF CHRONIC ILLNESS CARE
- 8.6. CLINICAL COMPLEXITY IN CHRONIC ILLNESS CARE
- 8.7. DESIGNING FOR COMPLEXITY THROUGH ALIGNMENT OF PROBLEMS AND PRACTICE SOLUTIONS
- 8.8. THE NATURE OF COMPLEX ADAPTIVE SYSTEMS
- 8.9. THE CHRONIC CARE MODEL
- 8.10. CARE COORDINATON AND TRANSITIONS
- 8.11. PATIENT SELF-MANAGEMENT
- 8.12. CONCLUSION
- 8.13. SUMMARY
- 8.14. KEY TERMS
- 8.15. REVIEW QUESTIONS
- 8.16. DISCUSSION QUESTIONS
- 8.17. REFERENCES
- Chapter Eight ACTION GUIDE
-
9. SUPPORTING PATIENTS AND FAMILIES THROUGH PALLIATIVE CARE
- 9.1. LEARNING OBJECTIVES
- 9.2. THE NEED FOR PALLIATIVE CARE IN MODERN AMERICA
- 9.3. END-OF-LIFE EXPERIENCE YESTERDAY AND TODAY
- 9.4. PRINCIPLES OF PALLIATIVE CARE
- 9.5. REDUCING VARIATION IN END-OF-LIFE CARE
- 9.6. CORE PROCESSES IN PALLIATIVE CARE
- 9.7. CARE COORDINATION NEAR THE END OF LIFE
- 9.8. FORMAL PALLIATIVE CARE AND HOSPICE PROGRAMS
- 9.9. PLANNING FOR BOTH LIFE AND DEATH WITH ADVANCE DIRECTIVES
- 9.10. CONCLUSION
- 9.11. SUMMARY
- 9.12. KEY TERMS
- 9.13. REVIEW QUESTIONS
- 9.14. DISCUSSION QUESTIONS
- 9.15. REFERENCES
- Chapter Nine ACTION GUIDE
-
10. DESIGNING HEALTH SYSTEMS TO IMPROVE VALUE
- 10.1. LEARNING OBJECTIVES
- 10.2. FROM PARTS TO WHOLE
-
10.3. NEW VISION OF INTEGRATED SYSTEMS TO PRODUCE HIGH VALUE
- 10.3.1. Create Value-Based Competition
- 10.3.2. Learn from Toyota to Relentlessly Reduce Waste and Continuously Add Value
- 10.3.3. Christensen's Use of Different Business Models to Improve Health Care Value
- 10.3.4. Fisher's Work to Create Accountable Care Organizations that Provide High-Value Care
- 10.3.5. Learn What We Need to Know
- 10.4. THE EXECUTION TRIANGLE
- 10.5. LEADING CHANGE AT ALL LEVELS
- 10.6. CHANGING LOCAL CULTURE
- 10.7. THE PATH FORWARD FOR MAKING HIGH-VALUE HEALTH SYSTEMS
- 10.8. SUMMARY
- 10.9. KEY TERMS
- 10.10. REVIEW QUESTIONS
- 10.11. DISCUSSION QUESTIONS
- 10.12. REFERENCES
- Chapter Ten ACTION GUIDE
Product information
- Title: Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence, Second Edition
- Author(s):
- Release date: March 2011
- Publisher(s): Jossey-Bass
- ISBN: 9780470385340
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