Efnisyfirlit

• Front Matter
  • FOREWORD
  • DEDICATION
  • PREFACE
    • References
  • ACKNOWLEDGMENTS
  • INTRODUCTION
    • Need
    • Purpose
    • Scope and Treatment
    • Overview of the Contents
      • M3 Matrix
      • Dartmouth Microsystem Improvement Curriculum (DMIC)
    • How to Use This Book
    • References
  • THE EDITORS
  • THE CONTRIBUTORS
• PART ONE CASES AND PRINCIPLES
  • CHAPTER ONE SUCCESS CHARACTERISTICS OF HIGH-PERFORMING MICROSYSTEMS: Learning from the Best
    • Chapter Summary
    • True Structure of the System, Embedded Systems, and Need to Transform Frontline Systems
      • FIGURE 1.1. CHAIN OF EFFECT IN IMPROVING HEALTH CARE QUALITY.
      • Describing Clinical Microsystems
    • The Bladyka Case
      • FIGURE 1.2. FLOWCHART OF KEN BLADYKA'S JOURNEY THROUGH THE HEALTH SYSTEM.
      • FIGURE 1.3. ANATOMY OF A CLINICAL MICROSYSTEM.
      • Previous Research on Microsystems, Organizational Performance, and Quality
      • Study of Clinical Microsystems
    • Research Design
      • FIGURE 1.4. RESEARCH DESIGN FOR STUDY OF TWENTY CLINICAL MICROSYSTEMS.
      • Sampling
      • Data Collection
      • Data Analysis
    • Results
      • Success Characteristics of High-Performing Sites
        • FIGURE 1.5. SUCCESS CHARACTERISTICS OF HIGH-PERFORMING CLINICAL MICROSYSTEMS.
      • Principles Associated with the Success Characteristics
        • TABLE 1.1. SCOPE OF PRIMARY SUCCESS CHARACTERISTICS AND ILLUSTRATIVE UNDERLYING PRINCIPLES.
      • Specific Examples of Success Characteristics
        • TABLE 1.2. SPECIFIC EXAMPLES OF THE PRIMARY SUCCESS CHARACTERISTICS.
      • Best Practices: Processes and Methods Associated with High Performance
      • Discussion
        • TABLE 1.3. ILLUSTRATIVE BEST PRACTICES USED BY HIGH-PERFORMING CLINICAL MICROSYSTEMS.
    • Practical Implications
    • Conclusion
      • APPENDIX 1.1. THE TWENTY SITES EXAMINED IN THE CLINICAL MICROSYSTEM STUDY.
    • References
  • CHAPTER TWO DEVELOPING HIGH-PERFORMING MICROSYSTEMS
    • Chapter Summary
    • Case Study: A Decade of Progress for an Intensive Care Nursery
      • Initial Stimulus and First Project: Quiet Pleases, 1992
        • FIGURE 2.1. VALUE COMPASS FOR THE DHMC INTENSIVE CARE NURSERY.
        • FIGURE 2.2. NOISE LEVELS IN THE ICN INTERMEDIATE CARE UNIT BEFORE AND AFTER QUIET PLEASES.
      • System Cost-Cutting Imperatives and Adaptive Responses, 1994 to 1997
        • FIGURE 2.3. ICN MEDIAN COST PER INFANT ADMITTED IN 1996–1997 INTENSIVE CARE NURSERY.
      • Collaborative Work with VON: 1995 to 2003
        • FIGURE 2.4. LONGITUDINAL TRENDS IN NUMBER OF DAYS ICN INFANTS SPEND ON MECHANICAL VENTILATION.
      • Evolutionary Principles: Transformation of Improvement Patterns
        • Begin with the Intention to Excel
        • Involve All the Players
        • Focus on Values That Matter
        • Keep Both Discipline and Rhythm
        • Use Measurement and Feedback
        • Create a Learning System
    • A Model of Development and a Curriculum to Catalyze Microsystem Growth
      • A Microsystem's Developmental Journey
        • Stage 1: Create Awareness of Our Clinical Unit as an Interdependent Group of People with the Capacity to Make Changes
          • FIGURE 2.5. A MODEL FOR A MICROSYSTEM'S DEVELOPMENTAL JOURNEY.
        • Stage 2: Connect Our Routine Daily Work to the High Purpose of Benefiting Patients; See Ourselves as a System
        • Stage 3: Respond Successfully to a Strategic Challenge
        • Stage 4: Measure the Performance of Our System as a System
        • Stage 5: Successfully Juggle Multiple Improvements While Taking Excellent Care of Patients, ... as We Continue to Develop an Enhanced Sense of Ourselves as a System
      • A Model Curriculum for the Developmental Journey
        • Studio Course Principles
        • Three-Thread Tactic
    • Conclusion
    • References
  • CHAPTER THREE LEADING MICROSYSTEMS
    • Chapter Summary
    • Leader, Leadership, Leading
    • Recap of Methods
    • Three Fundamental Processes of Leading: What Clinical Microsystem Team Members Observe and Report
      • Building Knowledge
      • Taking Action
        • TABLE 3.1. BUILDING KNOWLEDGE IN CLINICAL MICROSYSTEMS: VIEWS ON LEADING QUOTED FROM OUR INTERVIEWS.
        • TABLE 3.2. TAKING ACTION IN CLINICAL MICROSYSTEMS: VIEWS ON LEADING QUOTED FROM OUR INTERVIEWS.
      • Reviewing and Reflecting: A View from the Balcony
        • TABLE 3.3. REVIEWING AND REFLECTING IN CLINICAL MICROSYSTEMS: VIEWS ON LEADING QUOTED FROM OUR INTERVIEWS.
    • Discussion
      • Leading and Being
      • Leading Macrosystems to Foster Strong Microsystems
    • Conclusion
    • References
  • CHAPTER FOUR LEADING MACROSYSTEMS AND MESOSYSTEMS FOR MICROSYSTEM PEAK PERFORMANCE
    • Chapter Summary
    • Case Study: A True Story, with Names Changed to Protect the Innocent
      • Framing the Challenge
        • FIGURE 4.1. A VIEW OF THE MULTILAYERED HEALTH SYSTEM.
        • FIGURE 4.2. THE HEALTH CARE SYSTEM AS AN INVERTED PYRAMID.
      • Implications for Health Care Leaders
    • Leadership Frameworks: Some of the Best Approaches
      • Bossidy and Charan
        • TABLE 4.1. LEADERSHIP FRAMEWORKS AND CHALLENGES.
      • Malcolm Baldrige National Quality Award
        • FIGURE 4.3. BOSSIDY AND CHARAN'S FRAMEWORK FOR EXECUTION.
        • FIGURE 4.4. THE BALDRIGE PROCESS OF IMPROVEMENT.
      • Bolman and Deal
        • TABLE 4.2. BOLMAN AND DEAL'S FOUR COMPLEMENTARY LEADERSHIP FRAMEWORKS, WITH BARRIERS AND STRATEGIES.
      • Greenleaf
      • Kotter
      • Weick
        • TABLE 4.3. HIGHLIGHTS OF ROBERT GREENLEAF'S DARTMOUTH COLLEGE LECTURES.
        • EXHIBIT 4.1. KOTTER'S EIGHT-STEP PROCESS FOR LEADING LARGE-SCALE CHANGE.
        • TABLE 4.4. EITHER-OR STATES OF ORGANIZATIONAL CHANGE.
        • TABLE 4.5. SYSTEM EXAMPLES ASSOCIATED WITH LOOSE AND TIGHT COUPLING.
        • TABLE 4.6. MATCHING CHANGE STRATEGIES TO THE COUPLING SITUATION.
      • Toyota Approach
        • Way of Work
          • FIGURE 4.5. THE TOYOTA PYRAMID.
        • Tools and Methods of Change
          • EXHIBIT 4.2. TOYOTA'S FOURTEEN PRINCIPLES.
        • Emergent Learning Process
      • A Synopsis of Leadership Frameworks
      • Some Unique Features of the Health Care System
    • Leading Large Health Systems to Peak Performance Using Microsystem Thinking
      • Learning: Understanding Microsystems by Using Multiple Frames
        • FIGURE 4.6. EIGHT FRAMES FOR EXPLORING MICROSYSTEMS.
      • Doing: Leading Macrosystems by Deploying and Executing the Plan
        • Action Step 1: Bring Meaning to the Work
        • Action Step 2: Create the Context of the Whole
        • Action Step 3: Define Possibilities and Limitations
        • Action Step 4: Create Supportive Infrastructures for Health Information and Human Resources
        • Action Step 5: Stay Connected
        • Action Step 6: Drive Out the Fear of Change
      • Connecting: Leading Mesosystems by Connecting the Front Office with the Front Line
    • Conclusion
      • EXHIBIT 4.3. LEADING THE MESOSYSTEM.
    • References
  • CHAPTER FIVE DEVELOPING PROFESSIONALS AND IMPROVING WORKLIFE
    • Chapter Summary
    • Case Study: Staff Development at Massachusetts General Hospital Downtown Associates
      • Comments
      • Recruitment, Attraction, and Selection of Staff
      • Orientation of Staff
      • Ongoing Training and Education
        • TABLE 5.1. WORKSTATION ASSIGNMENTS AT MGH DOWNTOWN.
      • Performance Management
        • TABLE 5.2. EVALUATION SHEET FOR PERFORMANCE EVALUATION PROGRAM (PEP), SHOWING CATEGORIES AND DEFINITIONS.
      • Information Systems and Electronic Support to Optimize Staff Roles
      • Tips from the Case Study
        • TABLE 5.3. STAFF COMMENTS THAT SUPPORT THE HUMAN RESOURCE VALUE CHAIN CONCEPT.
      • Principles
        • Mission, Vision, Principles (MVPs)
          • TABLE 5.4. STAFF COMMENTS THAT SUPPORT SUCCESS CHARACTERISTICS.
        • Climate
        • Value Chain
        • Two Jobs
      • Helpful Resources and Methods
        • Gaining Knowledge
          • FIGURE 5.1. CLINICAL MICROSYSTEM SHORT STAFF SURVEY.
          • TABLE 5.5. EXAMPLES OF SKILLS ADDRESSED IN A PERSONAL SKILLS ASSESSMENT.
        • Planning Action
    • Conclusion
    • References
  • CHAPTER SIX PLANNING PATIENT-CENTERED SERVICES
    • Chapter Summary
    • Planning Patient-Centered Services and the 5 P's
    • Case Study: Planning Services for Subpopulations of Patients to Best Provide Care for Individual Patients
      • A Typical Visit
      • Comments
        • TABLE 6.1. EVERGREEN WOODS'S ADDITIONAL SUCCESS ELEMENTS AND THEIR LINKS TO THE 5 P'S.
    • A Developmental Journey: Beginning to Assess, Understand, and Improve a Clinical Microsystem
      • Getting Started: Diagnosing and Treating a Clinical Microsystem
        • Know Your Purpose
        • Know Your Patients
          • TABLE 6.2. KNOW THE P'S FOR CLINICAL MICROSYSTEMS ACROSS THE HEALTH CONTINUUM.
        • Know Your Professionals
        • Know Your Processes
    • Analysis and Improvement of Processes
      • Know Your Patterns
        • TABLE 6.3. PRACTICE CORE AND SUPPORTING PROCESSES ASSESSMENT.
      • Putting It All Together: Planning Services
        • FIGURE 6.1. HIGH-LEVEL VIEW OF A PRIMARY CARE CLINICAL MICROSYSTEM.
      • Discussion
        • Intentional Planning of Services and the Value of Meeting for Service Planning
          • TABLE 6.4. ASSESSING YOUR PRACTICE DISCOVERIES AND ACTIONS: THE P'S.
          • TABLE 6.5. ASSESSING YOUR PRACTICE DISCOVERIES AND ACTIONS: COMMON OVERSIGHTS AND WASTES.
    • A Huddle in Plastic Surgery
      • Success of the Pilot Huddles
      • Benefits
      • Key Learnings Noticed
        • Inside-Out Planning
        • Interdependency and Involvement
    • Conclusion
    • References
  • CHAPTER SEVEN PLANNING PATIENT-CENTERED CARE
    • Chapter Summary
    • Planning Care Well: Exemplary Clinical Microsystems
      • FIGURE 7.1. SCHEMATIC OF THE PLANNED (CHRONIC) CARE MODEL.
      • TABLE 7.1. COMMON MYTHS REJECTED BY EFFECTIVE CLINICAL MICROSYSTEMS.
    • Planning Care in Any Microsystem
      • FIGURE 7.2. PLANNING CARE AND PATIENT SELF-MANAGEMENT: SERVICE AND INFORMATION FLOW IN A MICROSYSTEM.
      • TABLE 7.2. ATTRIBUTES OF PLANNED CARE.
    • A Low-Tech Example for Ambulatory Services: CARE Vital Signs
      • Checking
      • Activating
      • Reinforcing
      • Engineering
        • FIGURE 7.3. EXAMPLE OF USING A CARE VITAL SIGNS FORM.
    • Conclusion
    • References
  • CHAPTER EIGHT IMPROVING PATIENT SAFETY
    • Chapter Summary
    • Microsystem Patient Safety Scenario
      • FIGURE 8.1. MICROSYSTEM PATIENT SAFETY SCENARIO.
      • FIGURE 8.2. HADDON MATRIX ANALYZING AN AUTO ACCIDENT.
      • FIGURE 8.3. COMPLETED SAFETY MATRIX FOR ALLISON'S SCENARIO.
    • Case Study: Dartmouth-Hitchcock PainFree Program
      • Discussion
      • Principles for Safety in Clinical Microsystems
        • Principle 1: Errors Are Human Nature and Will Happen Because Humans Are Not Infallible
        • Principle 2: The Microsystem Is the Key Unit of Analysis and Training
        • Principle 3: Design Systems to Identify, Prevent, Absorb, and Mitigate Errors
        • Principle 4: Create a Culture of Safety
        • Principle 5: Talk to and Listen to Patients
        • Principle 6: Integrate Practices from Human Factors Engineering into Microsystem Functioning
    • Conclusion
      • TABLE 8.1. LINKAGE BETWEEN MICROSYSTEM CHARACTERISTICS AND PATIENT SAFETY.
    • References
  • CHAPTER NINE CREATING A RICH INFORMATION ENVIRONMENT
    • Chapter Summary
    • Case Study 1: Specialty Care: Dartmouth-Hitchcock Spine Center
      • A Typical Illness Episode: Health Outcomes Tracking and More
      • Other Facts About the Spine Center
        • FIGURE 9.1. PATIENT VALUE COMPASS FOR A TYPICAL SPINE PATIENT.
    • Case Study 2: Overlook Hospital Emergency Department
      • A Glimpse of the Uses of Data, Real-Time Flow Monitoring, and More
      • Other Facts About the Overlook ED
    • Case Study 3: Intermountain Health Care Shock Trauma Intensive Care Unit
      • Daily Work: The Wired Patient and Real-Time Monitoring
      • Other Facts About the STRICU
    • Tips and Principles to Foster a Rich Information Environment
      • Principle 1: Design It—Provide Access to a Rich Information Environment
      • Principle 2: Connect with It—Use Information to Connect Patients to Staff and Staff to Staff
        • TABLE 9.1. TIPS FOR FOSTERING A RICH INFORMATION ENVIRONMENT.
      • Principle 3: Measure It—Develop Performance Goals and Linked Measures That Reflect Primary Values and Core Competencies Essential for Providing Needed Patient Services
      • Principle 4: Use It for Betterment—Measure Processes and Outcomes, Collect Feedback Data, and Redesign Continuously Based on Data
    • Discussion
      • Information Is the Connector of All to All
      • Designing Information Flow to Support the Smallest Replicable Units of Activity
      • Making Progress by Building on Three Useful Frameworks
        • Framework 1: Feed Forward and Feedback—Can We Use Data to Do the Right Thing Right the First Time and Every Time?
          • FIGURE 9.2. FEED FORWARD AND FEEDBACK IN A MICROSYSTEM: THE SPINE CENTER DESIGN FOR INFORMATION FLOW.
        • Framework 2: Patient Value Compass—Can We Use Data to Measure and Improve the Quality and Value of Care?
        • Framework 3: Balanced Scorecard—Can We Use Data to Measure and Improve the Performance of the Microsystem?
          • FIGURE 9.3. PATIENT VALUE COMPASS: SPINE CENTER HERNIATED DISK PATIENTS.
    • Conclusion
      • FIGURE 9.4. BALANCED SCORECARD FOR THE SPINE CENTER.
    • References
• PART TWO ACTIVATING THE ORGANIZATION AND THE DARTMOUTH MICROSYSTEM IMPROVEMENT CURRICULUM
  • CHAPTER TEN OVERVIEW OF PATH FORWARD AND INTRODUCTION TO PART TWO
    • Chapter Purpose
    • Recap of Part One and Overview of Part Two
    • Using Real Case Studies and Practical Applications of Microsystem Thinking, Methods, and Tools
    • Working at All Levels of a Health System
      • Moving from Improvement Projects to Improving Systems
        • FIGURE 10.1. EVOLUTION IN APPROACHES TO IMPROVING HEALTH SYSTEM QUALITY: FROM PROJECTS TO MESOSYSTEMS TO MACROSYSTEMS.
        • EXHIBIT 10.1. LETTER TO THE EDITOR ABOUT A CLINICAL PROGRAM WITH A LOCAL AND NATIONAL REPUTATION.
      • Using the M3 Matrix to Guide Actions at All Health System Levels
      • Engaging the Whole Person in Doing the Work
        • FIGURE 10.2. THE M3 MATRIX: SUGGESTIONS FOR LEADERSHIP ACTIONS AT THREE LEVELS OF A HEALTH SYSTEM.
        • Ask for Two Jobs: Providing Quality Services and Improving the Quality of Service
        • Use Esther's Story: Engage the Head, the Hand, and the Heart
          • EXHIBIT 10.2. IMPROVING PATIENT FLOW: THE ESTHER PROJECT IN SWEDEN.
    • Focusing on the Microsystem Level
      • Understanding the Role of Experiential Learning in the Improvement of Care
        • FIGURE 10.3. EXPERIENTIAL LEARNING MODEL.
      • Using Experiential Learning to Advance the Developmental Journey of Microsystems
      • Adapting DMIC to Different Settings and Conditions
        • TABLE 10.1. DARTMOUTH MICROSYSTEM IMPROVEMENT CURRICULUM.
      • Understanding the Value and Composition of a Lead Improvement Team
    • Review Questions
    • Prework
    • References
  • CHAPTER ELEVEN INTRODUCTION TO MICROSYSTEM THINKING
    • Chapter Purpose
    • What Is a System in Health Care?
      • FIGURE 11.1. HEALTH CARE VIEWED FROM A SYSTEMS PERSPECTIVE.
      • FIGURE 11.2. HEALTH CARE IS AN OPEN SYSTEM, CAPABLE OF CONTINUAL IMPROVEMENT.
    • How Did Clinical Microsystem Knowledge Evolve?
    • What Is a Clinical Microsystem?
    • Where Do Clinical Microsystems Fit in the Health Care Delivery System?
      • FIGURE 11.3. THE EMBEDDED SYSTEMS OF HEALTH CARE.
    • What Does a Clinical Microsystem Look Like?
    • Why Focus on the Clinical Microsystem?
    • How Do Clinical Microsystems Link to Crossing the Quality Chasm?
      • FIGURE 11.4. THE PHYSIOLOGY OF A MICROSYSTEM: A GENERIC MODEL.
    • What Were the Findings of the Dartmouth Clinical Microsystem Research?
    • What Does a Microsystem's Developmental Journey Look Like?
      • FIGURE 11.5. A MICROSYSTEM'S SELF-AWARENESS JOURNEY.
    • Conclusion
      • FIGURE 11.6. IMPROVEMENT RAMP.
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • References
  • CHAPTER TWELVE EFFECTIVE MEETING SKILLS I
    • Chapter Purpose
    • FIGURE 12.1. IMPROVEMENT RAMP: MEETING SKILLS.
    • What Is a Productive and Effective Meeting?
    • Why Use Meeting Skills and Roles?
    • What Are Effective Meeting Roles?
      • Can the Leader and Facilitator Roles Be Combined?
      • Can the Leader and Recorder Roles Be Combined?
      • Should the Facilitator Be an Outsider?
    • What Are the Phases of an Effective Meeting?
    • What Processes Are Evident in an Effective Meeting?
    • What Is the Seven-Step Meeting Process?
    • What Does a Meeting Agenda Template Look Like?
      • FIGURE 12.2. SAMPLE MEETING AGENDA TEMPLATE.
    • What Are the Ground Rules for Meetings?
    • What Are Some Tips for Getting Started with Productive Meetings?
    • How Do You Keep a Rhythm of Improvement?
      • FIGURE 12.3. RHYTHM OF IMPROVEMENT.
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
        • FIGURE 12.4. SAMPLE ICCU MEETING AGENDA.
    • Review Questions
    • Between Sessions Work
    • Reference
  • CHAPTER THIRTEEN ASSESSING YOUR MICROSYSTEM WITH THE 5 P'S
    • Chapter Purpose
    • FIGURE 13.1. IMPROVEMENT RAMP: ASSESSMENT.
    • How Does an Interdisciplinary Lead Improvement Team Begin to Assess and Improve a Clinical Microsystem?
    • What Does the 5 P's Framework Look Like?
    • What Resources Are Available to Guide the 5 P's Assessment?
    • What Is a Helpful Way to Introduce Your Team to the Assessment Process?
    • What Are the 5 P's?
      • Purpose
      • Patients
      • Professionals
      • Processes
      • Patterns
    • What Should You Do with the Assessment Findings?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
        • FIGURE 13.2. ICCU WALL POSTER FOR THE 5 P'S MICROSYSTEM ASSESSMENT.
    • Review Questions
    • Between Sessions Work
      • FIGURE 13.3. PLASTIC SURGERY SECTION ACCESS PATTERNS.
    • References
  • CHAPTER FOURTEEN THE MODEL FOR IMPROVEMENT: PDSA ↔ SDSA
    • Chapter Purpose
    • FIGURE 14.1. IMPROVEMENT RAMP: MODEL FOR IMPROVEMENT.
    • What Is the Model for Improvement?
      • FIGURE 14.2. MODEL FOR IMPROVEMENT.
    • Why Use the Model for Improvement?
    • How Does the Model Fit into the Improvement Process?
      • FIGURE 14.3. THEMES, AIMS, PROCESSES, AND PDSA CYCLES.
    • What Is the PDSA Part of the Model?
      • FIGURE 14.4. THE COMPLETE PDSA CYCLE.
    • What Are the Benefits of Using PDSA?
    • What Is Involved in Each of the Four Steps of Plan, Do, Study, and Act?
    • What Is the SDSA Cycle?
      • FIGURE 14.5. THE BACK-AND-FORTH RELATIONSHIP OF PDSA AND SDSA.
    • What Is Involved in Each of the Four Steps of Standardize, Do, Study, and Act?
      • FIGURE 14.6. THE COMPLETE SDSA CYCLE.
    • What Tools Can Assist Your PDSA Cycle ↔ SDSA Implementation?
    • What Are Some Tips for Using the PDSA ↔ SDSA Method?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
        • FIGURE 14.7. THE ICCU'S PDSA RAMP OF TESTS.
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • References
  • CHAPTER FIFTEEN SELECTING THEMES FOR IMPROVEMENT
    • Chapter Purpose
    • FIGURE 15.1. IMPROVEMENT RAMP: THEME.
    • What Is a Theme for Improvement?
    • Why Use a Theme?
    • What Are the Theme Selection Considerations?
      • FIGURE 15.2. KEY THEMES AND COMPONENTS OF IDEAL PRACTICES.
    • What Process Can You Use to Generate Theme Ideas and Select a First Theme?
    • What Are the Next Steps?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • References
  • CHAPTER SIXTEEN IMPROVEMENT GLOBAL AIM
    • Chapter Purpose
    • What Is a Global Aim?
      • FIGURE 16.1. IMPROVEMENT RAMP: GLOBAL AIM.
    • Why Use a Global Aim?
    • How Do You Write a Global Aim?
    • What Are the Next Steps?
      • FIGURE 16.2. TEMPLATE FOR WRITING A GLOBAL AIM STATEMENT.
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
  • CHAPTER SEVENTEEN PROCESS MAPPING
    • Chapter Purpose
    • FIGURE 17.1. IMPROVEMENT RAMP: PROCESS MAPPING.
    • What Is Process Mapping?
    • Why Use Process Mapping?
      • Definition of a Process
      • Definition of a Flowchart
    • What Are the Commonly Used Flowchart Symbols?
      • FIGURE 17.2. FLOWCHART SYMBOLS.
    • What Does a High-Level Flowchart Look Like?
    • What Does a Detailed Flowchart Look Like?
      • FIGURE 17.3. HIGH-LEVEL FLOWCHART OF A MEDICAL OFFICE VISIT.
    • What Are Some Tips for Creating a Flowchart?
      • FIGURE 17.4. DETAILED FLOWCHART OF TREATMENT PROCESS FOR CYSTIC FIBROSIS–RELATED DIABETES (CFRD).
    • What Does a Deployment Flowchart Look Like?
    • What Are Some Tips for Creating a Deployment Flowchart?
      • FIGURE 17.5. SECTION OF DEPLOYMENT FLOWCHART FOR ENROLLMENT IN OUTPATIENT CYSTIC FIBROSIS CLINIC.
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
        • FIGURE 17.6. HIGH-LEVEL FLOWCHART OF ICCU ADMISSION PROCESS.
        • FIGURE 17.7. HIGH-LEVEL FLOWCHART FOR BEGINNING OF BREAST REDUCTION PROCESS.
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • Reference
  • CHAPTER EIGHTEEN SPECIFIC AIM
    • Chapter Purpose
    • What Is a Specific Aim?
      • FIGURE 18.1. IMPROVEMENT RAMP: SPECIFIC AIM.
    • Why Use a Specific Aim?
    • Where Do Specific Aims Come From?
    • Where Does the Specific Aim Fit in the Overall Improvement Process?
    • How Do You Write a Specific Aim?
    • What Are the Next Steps?
      • FIGURE 18.2. TEMPLATE FOR WRITING A SPECIFIC AIM STATEMENT.
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • References
  • CHAPTER NINETEEN CAUSE AND EFFECT DIAGRAMS
    • Chapter Purpose
    • FIGURE 19.1. IMPROVEMENT RAMP: CAUSE AND EFFECT DIAGRAMS.
    • What Is a Cause and Effect Diagram?
      • FIGURE 19.2. WEB OF CAUSATION.
    • Why Use a Fishbone Diagram?
    • What Is the Structure of a Fishbone Diagram?
    • What Does a Completed Fishbone Look Like?
      • FIGURE 19.3. FISHBONE DIAGRAM.
      • FIGURE 19.4. FISHBONE DIAGRAM SHOWING CAUSES OF LENGTHY APPOINTMENTS.
    • What Are Some Tips for Creating a Fishbone Diagram?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
        • FIGURE 19.5. FISHBONE DIAGRAM FOR ICCU BED ASSIGNMENT.
      • Plastic Surgery Section
    • Review Questions
      • FIGURE 19.6. FISHBONE DIAGRAM FOR PLASTIC SURGERY APPOINTMENT BACKLOG.
    • Between Sessions Work
    • References
  • CHAPTER TWENTY EFFECTIVE MEETING SKILLS II: Brainstorming and Multi-Voting
    • Chapter Purpose
    • FIGURE 20.1. IMPROVEMENT RAMP: BRAINSTORMING AND MULTI-VOTING.
    • What Is Brainstorming?
    • What Are the Benefits of Brainstorming?
    • What Are Some Different Types of Brainstorming?
    • What Are Some Tips for Conducting Brainstorming?
    • What Is Multi-Voting?
    • Do Teams Always Multi-Vote After a Brainstorming Session?
    • How Do You Multi-Vote?
    • What Does a Brainstorming Session with a Multi-Voting Outcome Look Like?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
        • FIGURE 20.2. BRAINSTORMING AND MULTI-VOTING EXAMPLE.
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • Reference
  • CHAPTER TWENTY-ONE CHANGE CONCEPTS
    • Chapter Purpose
    • FIGURE 21.1. IMPROVEMENT RAMP: CHANGE IDEAS.
    • What Is a Change Concept?
    • Why Use Change Concepts?
    • How Can You Use Change Concepts in a Process?
      • TABLE 21.1. LANGLEY'S CHANGE CONCEPTS.
    • What Are the Next Steps?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
        • FIGURE 21.2. CHANGE CONCEPTS APPLIED TO A CLINICAL PROCESS.
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • References
  • CHAPTER TWENTY-TWO MEASUREMENT AND MONITORING
    • Chapter Purpose
    • What Are Measures, What Makes Measures Good, and How Do They Relate to Aims?
      • FIGURE 22.1. IMPROVEMENT RAMP: MEASUREMENT.
    • What Is a Run Chart?
      • FIGURE 22.2. RUN CHART DISPLAYING FASTING BLOOD SUGAR LEVELS.
      • FIGURE 22.3. RUN CHART DISPLAYING NO SHOWS.
      • FIGURE 22.4. RUN CHART DISPLAYING DAYS TO THIRD NEXT AVAILABLE APPOINTMENT.
    • What Are the Benefits of Using a Run Chart?
    • How Do Run Charts Fit in the Overall Improvement Process?
    • What Do Run Charts Tell You About Your Performance Level and Variation?
    • What Are Special Cause and Common Cause Variation?
    • How Do You Make a Run Chart?
      • FIGURE 22.5. WORKSHEET FOR COLLECTING DATA TO MEASURE A KEY VARIABLE.
    • How Do You Interpret Run Chart Results?
    • What Is a Control Chart?
      • FIGURE 22.6. GROSS ANATOMY OF A RUN CHART.
      • FIGURE 22.7. GROSS ANATOMY OF A CONTROL CHART.
      • FIGURE 22.8. CONTROL CHART FOR INDIVIDUALS WITH DIABETES IN A GENERAL MEDICINE PRACTICE.
    • What Is the Theory Behind Control Charts?
      • FIGURE 22.9. NORMAL DISTRIBUTION, AKA THE BELL CURVE.
      • FIGURE 22.10. CONTROL CHART IN RELATION TO NORMAL DISTRIBUTION.
    • What Are the Benefits of Using a Control Chart Instead of a Run Chart?
    • What Are the Different Kinds of Control Charts?
    • What Is an XmR Control Chart?
      • FIGURE 22.11. GROSS ANATOMY OF AN XMR CHART.
      • How Do You Make an XmR Control Chart?
        • FIGURE 22.12. XMR CHART SHOWING FASTING BLOOD SUGAR VARIANCE IN ONE PATIENT OVER ONE MONTH.
    • How Do You Interpret Control Chart Results?
      • FIGURE 22.13. SPECIAL CAUSE SIGNAL: EIGHT CONSECUTIVE POINTS ON SAME SIDE OF CENTER LINE.
      • FIGURE 22.14. SPECIAL CAUSE SIGNAL: SIX CONSECUTIVE POINTS TRENDING IN THE SAME DIRECTION (UPWARD IN THIS CASE).
      • FIGURE 22.15. SPECIAL CAUSE SIGNAL: A POINT OUTSIDE A CONTROL LIMIT.
    • When Do You Recalculate Control Chart Values?
    • What Are Some Tips for Using Run Charts and Control Charts?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
    • Review Questions
    • Between Sessions Work
    • References
  • CHAPTER TWENTY-THREE ACTION PLANS AND GANTT CHARTS
    • Chapter Purpose
    • FIGURE 23.1. IMPROVEMENT RAMP: ACTION PLANS AND GANTT CHARTS.
    • What Is an Action Plan?
    • What Is a Gantt Chart?
    • Why Use Action Plans and Gantt Charts?
    • How Do You Write an Action Plan?
    • How Do You Create a Gantt Chart?
      • FIGURE 23.2. EXAMPLE OF A GANTT CHART.
    • What Are the Next Steps?
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
        • FIGURE 23.3. GANTT CHART FOR THE ICCU'S OVERALL SEVEN-MONTH IMPROVEMENT STRATEGY.
    • Review Questions
    • Between Sessions Work
    • Reference
  • CHAPTER TWENTY-FOUR FOLLOW THROUGH ON IMPROVEMENT: Storyboards, Data Walls, and Playbooks
    • Chapter Purpose
    • What Is the Importance of Follow Through?
    • What Can You Do to Follow Through?
    • What Are the Fundamentals of Improvement?
    • What Is a Data Wall?
    • What Is a Playbook?
    • How Is the Playbook Used?
    • How Do You Create a Playbook?
    • How Do You Maintain Your Playbook?
      • FIGURE 24.1. PLAYBOOK CHECKLIST TEMPLATE.
    • What Is a Storyboard?
    • How Do You Make a Storyboard?
    • Discussion
    • Case Studies
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
        • FIGURE 24.2. STORYBOARD DISPLAY OF THE ICCU IMPROVEMENT JOURNEY.
        • FIGURE 24.3. PLASTIC SURGERY SECTION DATA WALL.
    • Review Questions
    • Between Sessions Work
  • CHAPTER TWENTY-FIVE CONCLUSION: Continuing on the Path to Excellence
    • Looking Back
      • Intermediate Cardiac Care Unit (ICCU)
      • Plastic Surgery Section
    • Looking Forward and an Invitation: Make It Personal and Make It Happen
• Back Matter
  • APPENDIX A: PRIMARY CARE WORKBOOK
    • Strategies for Improving the Place Where Patients, Families, and Careteams Meet
    • The Path Forward
      • Step 1: Organize a Lead Improvement Team
      • Step 2: Do the Assessment
      • Step 3: Make a Diagnosis
      • Step 4: Treat Your Microsystem
      • Step 5: Follow Up
    • Step 1: Organize a Lead Improvement Team
    • Step 2: Assess Your Primary Care Practice
      • Microsystem Assessment of Data Sources and Data Collection Actions
        • FIGURE A.1. MICROSYSTEM ASSESSMENT OF DATA SOURCES AND DATA COLLECTION ACTIONS.
        • FIGURE A.2. PRIMARY CARE PRACTICE PROFILE.
      • Patients
        • FIGURE A.3. POINT OF SERVICE SURVEY: PATIENT/FAMILY SATISFACTION WITH PRIMARY CARE PRACTICE ACCESS.
        • FIGURE A.4. PRIMARY CARE PRACTICE PATIENT VIEWPOINT SURVEY.
        • FIGURE A.5. THROUGH THE EYES OF YOUR PATIENTS.
        • FIGURE A.6. ASSESSMENT OF CARE FOR CHRONIC CONDITIONS.
      • Professionals
        • FIGURE A.7. PRIMARY CARE STAFF SATISFACTION SURVEY.
        • FIGURE A.8. PRIMARY CARE STAFF PERSONAL SKILLS ASSESSMENT.
        • FIGURE A.9. PRIMARY CARE STAFF ACTIVITY SURVEY SHEETS.
      • Processes
        • FIGURE A.10. PRIMARY CARE PRACTICE PATIENT CYCLE TIME.
        • FIGURE A.11. PRIMARY CARE PRACTICE CORE AND SUPPORTING PROCESSES.
      • Patterns
        • FIGURE A.12. PRIMARY CARE PRACTICE UNPLANNED ACTIVITY TRACKING CARD.
        • FIGURE A.13. PRIMARY CARE PRACTICE TELEPHONE TRACKING LOG.
      • Metrics That Matter
        • FIGURE A.14. PRIMARY CARE PRACTICE METRICS THAT MATTER.
    • Step 3: Diagnose
    • Step 4: Treat Your Primary Care Practice
      • FIGURE A.15. PDSA SDSA WORKSHEET
    • Step 5: Follow Up
      • FIGURE A.16. HUDDLE WORKSHEET.
    • References
  • NAME INDEX
  • SUBJECT INDEX

  UM RAFBÆKUR Á HEIMKAUP.IS

  Bókahillan þín er þitt svæði og þar eru bækurnar þínar geymdar. Þú kemst í bókahilluna þína hvar og hvenær sem er í tölvu eða snjalltæki. Einfalt og þægilegt!
  
  Rafbók til eignar
  Rafbók til eignar þarf að hlaða niður á þau tæki sem þú vilt nota innan eins árs frá því bókin er keypt.
  
  Þú kemst í bækurnar hvar sem er
  Þú getur nálgast allar raf(skóla)bækurnar þínar á einu augabragði, hvar og hvenær sem er í bókahillunni þinni. Engin taska, enginn kyndill og ekkert vesen (hvað þá yfirvigt).
  
  Auðvelt að fletta og leita
  Þú getur flakkað milli síðna og kafla eins og þér hentar best og farið beint í ákveðna kafla úr efnisyfirlitinu. Í leitinni finnur þú orð, kafla eða síður í einum smelli.
  
  Glósur og yfirstrikanir
  Þú getur auðkennt textabrot með mismunandi litum og skrifað glósur að vild í rafbókina. Þú getur jafnvel séð glósur og yfirstrikanir hjá bekkjarsystkinum og kennara ef þeir leyfa það. Allt á einum stað.
  
  Hvað viltu sjá? / Þú ræður hvernig síðan lítur út
  Þú lagar síðuna að þínum þörfum. Stækkaðu eða minnkaðu myndir og texta með multi-level zoom til að sjá síðuna eins og þér hentar best í þínu námi.
  
  
  
  Fleiri góðir kostir
  - Þú getur prentað síður úr bókinni (innan þeirra marka sem útgefandinn setur)
  - Möguleiki á tengingu við annað stafrænt og gagnvirkt efni, svo sem myndbönd eða spurningar úr efninu
  - Auðvelt að afrita og líma efni/texta fyrir t.d. heimaverkefni eða ritgerðir
  - Styður tækni sem hjálpar nemendum með sjón- eða heyrnarskerðingu