Efnisyfirlit

• Front Matter
  • FOREWORD
    • References
  • PREFACE IMPROVEMENT AT THE FRONT LINE OF CARE
    • The Dartmouth Institute's Clinical Microsystems Course
    • Organization of the Microsystems Course
    • The Clinical Microsystem Model
      • FIGURE P.1 Clinical Microsystem Model.
    • Organization of This Book
      • FIGURE P.2 Infrastructual and Experiential Domains of the Clinical Microsystem.
      • Additional Features and Online Resources
  • ACKNOWLEDGMENTS
  • THE EDITORS
  • THE CONTRIBUTORS
• CHAPTER 1 INTRODUCING CLINICAL MICROSYSTEMS
  • LEARNING OBJECTIVES
  • MICROSYSTEMS IN HEALTH CARE
    • FIGURE 1.1 Many-to-One Diagram.
    • The Functional Unit in Health Care
      • FIGURE 1.2 The Simplest Clinical Microsystem.
      • FIGURE 1.3 Anatomy of a Microsystem.
  • A BROADER VIEW OF SYSTEMS AND MICROSYSTEMS
    • Systems Dynamics and Embedded Systems
      • FIGURE 1.4 Embedded Provider Units in a Health System.
    • The Institute of Medicine's Chain of Effect in Health Care
      • FIGURE 1.5 Supporting Microsystems for a Clinical Microsystem.
    • Horizontal and Vertical Levels of the Health Care System
      • FIGURE 1.6 Panoramic View of a Health System.
    • Microsystems and Their External Context
  • RESEARCH ON MICROSYSTEMS IN HEALTH CARE
    • Microsystem Research
      • FIGURE 1.7 External Mapping of a Clinic in the United Kingdom.
      • FIGURE 1.8 The Success Characteristics of High Performing Clinical Microsystems.
    • Microsystem in Macrosystem Research
    • Emerging Microsystem Research in Sweden and the Future
      • FIGURE 1.9 Jönköping County's Child HealthCare Collaboration.
      • FIGURE 1.10 Panoramic View of Jönköping County's Maternity and Newborn Mesosystem.
    • Organizing for Quality
      • Table 1.1 Bridging the Gaps: Jönköping, Sweden, Research Studies
      • FIGURE 1.11 Mesosystems as a Connector Entity.
  • THREE CONCEPTUAL IMPERATIVES IN THE WORK OF VALUE IMPROVEMENT
    • Imperative Number 1: Engage Everyone in Value Improvement
      • FIGURE 1.12 Annotated Sustainable Improvement Triangle.
      • FIGURE 1.13 Improvement Equation Annotated: Linking Evidence to Improvement.
    • Imperative Number 2: Work the Improvement Equation
    • Imperative Number 3: Frame Problems and Practice Solutions as Simple, Complicated, or Complex
      • FIGURE 1.14 Simple, Complicated, Complex Framework.
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter One ACTION GUIDE
    • INTRODUCTION TO THE 5PS
    • THE CLINICAL MICROSYSTEM PROCESS AND STRUCTURE OF THE 5PS MODEL
      • FIGURE AG1.1 Microsystem Anatomy Model.
      • FIGURE AG1.2 Primary Care Profile.
      • FIGURE AG1.3 Specialty Care Profile.
      • FIGURE AG1.4 Inpatient Profile.
    • EXTERNAL MAPPING TOOL
      • Table AG1.1 Assessing Your Practice Discoveries and Actions: The 5Ps
      • Table AG1.2 Supporting Microsystem 5Ps
      • FIGURE AG1.5 External Mapping Tool.
    • MICROSYSTEM ASSESSMENT TOOL (MAT)
      • Description and Use of MAT
      • Guidelines for Scoring with MAT
        • FIGURE AG1.6 Microsystem Assessment Tool.
        • Table AG1.3 Microsystem Assessment Tool (MAT) Definitions
        • Table AG1.4 Microsystem Assessment Tool (MAT) Worksheet
        • FIGURE AG1.7 Microsystem Assessment Tool (MAT) Scores.
      • Interpretation of Scores
• CHAPTER 2 PARTNERING WITH PATIENTS TO DESIGN AND IMPROVE CARE
  • LEARNING OBJECTIVES
  • THE AIM OF HEALTH CARE AND THE NEED TO PARTNER WITH PATIENTS
    • Table 2.1 Ten New Rules for the Twenty-First Century Health Care System
    • High-Value Care and Self-Care Statistics
      • The Value of Partnering with Patients
      • References
  • CONCEPTUAL FRAMEWORKS FOR PARTNERING WITH PATIENTS
    • Core Concepts
    • Target Diagram and Clinical Microsystem Model
      • FIGURE 2.1 Clinical Microsystem Physiology Model.
    • Kano Model of Satisfaction with Services
      • FIGURE 2.2 Kano Model for Understanding Customer Satisfaction.
    • Deming Model for Organizing Services as a System of Production
      • FIGURE 2.3 Deming Model: Organizing as a System of Care.
    • Wagner's Chronic Care Model and Lorig's Self-Management Model
      • FIGURE 2.4 Chronic Care Model.
      • Table 2.2 Patient Education Program
    • Amy's Experience in Clinical Microsystems
      • FIGURE 2.5 Amy's Breast Cancer Care Journey.
      • Reflections on Amy's experience
  • TACTICS FOR PARTNERING WITH PATIENTS
    • Feed Forward Health Status Assessment
    • Motivational Interviewing, Patient Contracting, and Goal Setting
    • Shared Decision Making and Shared Medical Appointments
    • Health Coaching and Information Prescriptions
      • Plastic Surgery, Access, and Shared Medical Appointments
  • PATIENTS AS INFORMANTS AND ADVISORS
    • Using Direct Observations to Improve Care
    • Interviews and Surveys
    • Value Stream Mapping
    • Patients and Families as Committee Members and Advisors
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Two ACTION GUIDE
    • GAINING CUSTOMER KNOWLEDGE
      • FIGURE AG2.1 Continuum of Methods for Gaining Customer Knowledge.
      • Observational Skills and Ethnography
        • FIGURE AG2.2 Through the Eyes of Your Patients.
        • FIGURE AG2.3 Observation Skills Worksheet.
        • FIGURE AG2.4 Microsystem Lenses Model.
    • TIPS FOR WRITING SURVEY ITEMS
      • FIGURE AG2.5 Tips and Lenses Worksheet.
      • Different Types of Survey Questions
        • Ratings
        • Opinions
        • Reports
        • Verbatim
      • Steps for Conducting a Written Survey
        • Table AG2.1 Opinion Survey
        • Structure of a Written Survey
          • FIGURE AG2.6 Flying a Plane and Conducting an Interview.
          • FIGURE AG2.7 Interview Worksheet 1.
          • FIGURE AG2.8 Interview Worksheet 2.
          • FIGURE AG2.9 Analysis and Interpretation.
    • INSTITUTE FOR PATIENT AND FAMILY-CENTERED CARE MATRIX
      • FIGURE AG2.10 Framework for Family Involvement in Quality Improvement.
    • VALUE STREAM MAPPING
      • FIGURE AG2.11 Value Stream Map Worksheet.
    • DEFINITIONS OF SELECTED VALUE STREAM MAPPING TERMS
      • FIGURE AG2.12 Value Stream Map Page 1.
• CHAPTER 3 IMPROVING SAFETY AND ANTICIPATING HAZARDS IN CLINICAL MICROSYSTEMS
  • LEARNING OBJECTIVES
  • CASE STUDY OF ORGANIZATIONAL FACTORS TO PROMOTE A CULTURE OF SAFETY
    • CASE STUDY CONTEXT: THE INTENSIVE CARE NURSERY AT THE CHILDREN'S HOSPITAL AT DARTMOUTH
      • Identification of, and Learning from Near Misses, Errors, and Adverse Events
      • Implementation of Practices to Promote Patient Safety (WHO)
    • Table 3.1 Workplace and Human Factors (WHO) Examples
    • Prevention of Nosocomial Infections
  • DISCUSSION
  • DEFINITIONS
    • FIGURE 3.1 Terms Related to Patient Safety.
  • IDENTIFICATION OF MEDICAL ERRORS AND ADVERSE EVENTS
    • CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
  • FREQUENCY OF ADVERSE EVENTS AND MEDICAL ERRORS
    • Table 3.2 Methods to Identify Medical Errors and Adverse Events
    • Causation of Medical Errors
    • The Swiss Cheese Model
      • CONDITIONS THAT CONTRIBUTE TO ERRORS AND ADVERSE EVENTS AS SEEN THROUGH THE WHO FRAMEWORK
        • Work Conditions: W
        • Human Conditions: H
        • Organizational Conditions: O
      • FIGURE 3.2 The Swiss Cheese Model of How Defenses, Barriers, and Safeguards May Be Penetrated by an Accident Trajectory.
    • Diagnostic Errors
    • Prevention of Medical Errors to Ensure Patient Safety
    • Proactive Identification and Mitigation of Error Risks
    • Implementation and Monitoring of Safety Practices
      • FIGURE 3.3 Principles of Developing and Implementing Patient Safety Interventions.
    • Learning from Errors
      • Work Conditions
      • Human Conditions
      • Organizational Conditions
    • Valuing a Culture of Safety
    • Responding to Medical Errors
    • Communicating with the Patient and the Patient's Family After an Error
    • Care of Involved Health Professionals
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Three ACTION GUIDE
    • 5S METHOD
      • Sort/Seiri (Organization)
        • FIGURE AG3.1 5S Method.
      • Straighten/Seiton (Orderliness)
      • Shine/Seiso (Cleanliness)
      • Standardize/Seiketsu (Adherence)
      • Sustain/Shitsuke (Self-Discipline)
    • CHECKLISTS
      • How to Make a Checklist
        • FIGURE AG3.2 5S Evaluation and Improvement Worksheet.
        • FIGURE AG3.3 Procedure Checklist.
  • FAILURE MODE AND EFFECTS ANALYSIS
    • How to Conduct the FMEA Process
      • Table AG3.1 Failure Mode and Effects Analysis
  • REHEARSALS OR SIMULATIONS
  • DESIGNING PATIENT SAFETY INTO THE MICROSYSTEM
    • Background
  • THE LINK BETWEEN SAFETY, THE MICROSYSTEM, AND MINDFULNESS
    • FIGURE AG3.4 Patient Safety Scenario.
    • FIGURE AG3.5 Haddon Matrix.
    • FIGURE AG3.6 Patient Safety Matrix.
    • Principle 1. Humans Are Error-Prone by Nature and so Errors Will Occur
    • Principle 2. The Microsystem Is the 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 AG3.2 Linkages to Safety
  • REFERENCES
• CHAPTER 4 USING MEASUREMENT TO IMPROVE HEALTH CARE VALUE
  • LEARNING OBJECTIVES
  • MEASURING WHAT MATTERS AT ALL LEVELS OF THE SYSTEM
    • FIGURE 4.1 Multiple Functions of Measurement Within Embedded Levels of a Health System.
    • SPECIALTY CARE CASE STUDY: DARTMOUTH-HITCHCOCK SPINE CENTER
      • A Typical Illness Episode: Health Outcomes Tracking and More
      • Other Facts About the Spine Center Information Environment
    • FIGURE 4.2 Patient Value Compass for a Typical Spine Patient.
    • Overlook Hospital Emergency Department Case Study
      • A Glimpse at the Uses of Data, Real-Time Flow Monitoring, and More
      • Other Facts About the Overlook ED's Success
    • Intermountain Health Care Shock Trauma Unit Case Study
      • The Wired Patient and Real-Time Monitoring and Management
      • Other Facts About the Environment
  • TIPS AND PRINCIPLES TO FOSTER A RICH INFORMATION ENVIRONMENT
    • Principle 1: Design It—Provide Access to a Rich Information Environment
      • Table 4.1 Tips to Foster a Rich Information Environment
    • Principle 2: Connect with It—Use Information to Connect Patients to Staff and Staff to Staff
    • 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
  • DESIGNING INFORMATION FLOW TO SUPPORT HIGH-VALUE CARE
    • Framework 1: Feed Forward and Feedback
      • FIGURE 4.3 The Spine Center Design for Information Flow.
    • Framework 2: Patient Value Compass
      • FIGURE 4.4 Value Compass Measures Over a Lifetime.
    • Framework 3: Balanced Scorecard—Can We Use Data to Measure and Improve?
      • FIGURE 4.5 Patient Value Compass: Herniated Disk Patients.
    • Comparing the Compass and the Scorecard
      • FIGURE 4.6 Balanced Scorecard: Spine Center Business Unit.
    • The Dashboard Metaphor
      • Table 4.2 Some Distinguishing Characteristics of the Value Compass and the Balanced Scorecard
    • Using the Cascades Metaphor to Measure at Different Levels of a System
      • FIGURE 4.7 Cascading Metrics Using Adverse Event Rates as an Example.
      • FIGURE 4.8 Cascading Metrics.
      • Measure What Matters Worksheet
        • CASE EXAMPLE: USING THE MEASURE WHAT MATTERS WORKSHEET IN NEONATAL INTENSIVE CARE UNITS
  • CONCLUSION
    • FIGURE 4.9 Sample Layout: Measures for Improvement.
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Four ACTION GUIDE
    • PATIENT VALUE COMPASS
      • FIGURE AG4.1 Clinical Value Compass Side A.
    • BALANCED SCORECARD
      • FIGURE AG4.2 Clinical Value Compass Side B.
    • MEASURE WHAT MATTERS WORKSHEET
      • FIGURE AG4.3 Strategic Performance Compass.
      • FIGURE AG4.4 Measure What Matters Page 1.
    • EXAMPLES OF DATA WALLS
    • REFERENCES
• CHAPTER 5 STARTING THE PATIENT'S CARE IN CLINICAL MICROSYSTEMS
  • LEARNING OBJECTIVES
  • THE ENTRY FUNCTIONS OF CLINICAL MICROSYSTEMS
    • Table 5.1 Critical Steps in the Health Care Journey
    • Access and Handoffs
      • Access to Care and Services
      • Systematically Improving Access to Care
      • Methods to Increase Access and Improve Flow
        • FIGURE 5.1 Change Concepts for Advanced Clinic Access.
      • Evaluating Successful Access to Care
        • Outpatient
          • Table 5.2 Methods for Improving Access and Flow in Clinical Mesosystems
        • Inpatient
    • Transitions and Handoffs
      • FIGURE 5.2 Patient Access to Care from the Catwalk.
      • Matching Patients' Needs with Their Plan of Care
        • References
      • FIGURE 5.3 The Catwalk of Post-Anesthesia Care.
      • Principles of Effective Transitions and Handoffs
      • Methods
        • FIGURE 5.4 Handoff Communication Checklist for Surgery.
        • FIGURE 5.5 RN to RN Handoff Tool.
        • FIGURE 5.6 SBAR Patient Report Guideline for Perioperative Services.
        • FIGURE 5.7 I Pass the Baton Handoffs and Health Care Transitions.
      • Evaluating Successful Care Transitions
        • Direct Assessment and Monitoring of Transition Metrics
        • Indirect Assessment and Monitoring of Downstream Outcomes
    • Orienting Patients to Navigate Care
      • Principles for Orienting Patients to Microsystems
      • Methods of Improving the Orientation Process
      • Evaluating Success of the Orientation Process
    • Initial Assessment and Plan of Care
      • FIGURE 5.8 Orientation Process for Parents Whose Infant Has Been Transferred to a Neonatal Intensive Care Unit.
      • Table 5.3 Steps and Methods for Analyzing and Improving the Orientation Process
      • Characteristics of Effective Care Plans
      • The Wagner Care Model
      • Evaluating Care Plan Success
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Five ACTION GUIDE
    • PROCESS MAPPING WITH FLOWCHARTS
      • FIGURE AG5.1 High-Level Flowchart.
      • FIGURE AG5.2 Drill Down Flowchart.
      • FIGURE AG5.3 Flowchart Symbol Key.
      • FIGURE AG5.4 Deployment Flow Diagram.
      • Deployment Charts
    • ACCESS MEASURES AND TOOLS
      • FIGURE AG5.5 Deployment Flow Example.
    • CARE VITAL SIGNS
      • FIGURE AG5.6 CARE Vital Signs Page 1.
      • FIGURE AG5.7 CARE Vital Signs Page 2.
    • REFERENCE
• CHAPTER 6 DESIGNING PREVENTIVE CARE TO IMPROVE HEALTH
  • LEARNING OBJECTIVES
  • THE WORK OF PREVENTIVE HEALTH CARE
    • Table 6.1 Sample List of Preventive Care Activities
    • Table 6.2 Overarching Care Needs of Patient and Family
    • CASE STUDY: THE SCOPE AND CHALLENGE OF PREVENTIVE CARE
  • AN ACTION-BASED TAXONOMY OF PREVENTIVE HEALTH SERVICES
    • Table 6.3 An Action-Based Taxonomy of Preventive Health Care
    • Principles for Designing and Improving Preventive Health Care in Clinical Microsystems
    • The Clinical Improvement Equation
      • FIGURE 6.1 Clinical Improvement Equation.
      • FIGURE 6.2 Knowledge Elements in Clinical Improvement.
    • Specific Questions to Support the Design and Improvement of Preventive Care
      • Table 6.4 Questions to Stimulate the Design and Improvement of Preventive Care
      • In Our Microsystem, What Diseases or Hazards Pose a Risk to Our Patients, and What Evidence-Based Interventions Can Mitigate These Risks?
      • In Our Microsystem, What Patient and Practice Characteristics Support or Impede Risk Reduction?
      • In Our Microsystem, How do We Maximize the Likelihood That Risk-Reducing Interventions Are Performed?
      • In Our Microsystem, How Do We Monitor Our Performance?
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Six ACTION GUIDE
    • RADIOLOGY MICROSYSTEM PREVENTIVE ACTIVITY OF MAMMOGRAPHY AND VAP BUNDLES IN CRITICAL CARE
      • FIGURE AG6.1 Radiology Flowchart.
• CHAPTER 7 PLANNING FOR RESPONSIVE AND RELIABLE ACUTE CARE
  • LEARNING OBJECTIVES
  • ANTICIPATING THE NEEDS OF ACUTELY ILL PATIENTS
  • DEFINING ACUTE CARE NEEDS OF PATIENTS AND FAMILIES
    • Table 7.1 Overarching Care Needs of Patient and Family
    • CASE STUDY: THE EXPERIENCE OF ACUITY
    • FIGURE 7.1 Pneumonia Deployment Flowchart.
  • AN OVERVIEW OF DESIGN REQUIREMENTS FOR ACUTE CARE
    • Time Is in the Foreground
    • Evidence-Based Algorithms and Structured Decision Making
    • Well-Defined (but Flexible) Roles Within the Clinical Microsystem
      • FIGURE 7.2 Pneumonia Care Algorithm.
    • Unique Role of Patient and Family
      • FIGURE 7.3 Who Seeks Care Where? Ecology of Medical Care 2001.
      • FIGURE 7.4 Change Concepts.
    • Planning for the Expected Surprise
      • FIGURE 7.5 Asthma Action Plan.
  • ADVANCED ACCESS AND EFFECTIVE CARE TRANSITIONS
    • Effective Care Transitions
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Seven ACTION GUIDE
    • FIGURE AG7.1 Microsystem Transitions and Handoffs.
• CHAPTER 8 ENGAGING COMPLEXITY IN CHRONIC ILLNESS CARE
  • LEARNING OBJECTIVES
  • AN INVITATION TO COMPLEXITY
    • Table 8.1 A Comparison of Acute and Chronic Disease
    • Table 8.2 Overarching Care Needs of Patient and Family
  • THE EXPERIENCE OF CHRONIC ILLNESS
    • CASE STUDY: THE EXPERIENCE OF CHRONIC ILLNESS
  • THE BURDEN OF CHRONIC ILLNESS
    • Table 8.3 Common Chronic Diseases in the United States
    • Table 8.4 Number of Chronic Conditions per Medicare Beneficiary
  • THE GOALS OF CHRONIC ILLNESS CARE
    • Table 8.5 Three Essential Goals of Chronic Illness Care
  • CLINICAL COMPLEXITY IN CHRONIC ILLNESS CARE
    • Table 8.6 Three Types of Activities: Simple, Complicated, and Complex
  • DESIGNING FOR COMPLEXITY THROUGH ALIGNMENT OF PROBLEMS AND PRACTICE SOLUTIONS
    • FIGURE 8.1 Aligning Levels of Problem and Practice Complexity.
    • Table 8.7 Aligning Simple, Complicated, and Complex Activities with Appropriate Solutions
  • THE NATURE OF COMPLEX ADAPTIVE SYSTEMS
    • Table 8.8 Features of Complex Adaptive Systems, Design Implications, and Examples
  • THE CHRONIC CARE MODEL
    • FIGURE 8.2 Chronic Care Model.
    • FIGURE 8.3 Clinical Value Compass.
    • FIGURE 8.4 Embedded Systems.
    • Self-Management Support
    • Delivery System Design
    • Decision Support
    • Clinical Information Systems
      • Is the Chronic Care Model Effective?
  • CARE COORDINATON AND TRANSITIONS
    • FIGURE 8.5 Radial Handoffs and Transitions in Chronic Illness Care.
  • PATIENT SELF-MANAGEMENT
    • FIGURE 8.6 The 5As Cycle of Self-Management Support.
    • FIGURE 8.7 My Action Plan.
    • FIGURE 8.8 Implementing the 5As Model in Clinical Microsystems.
  • CONCLUSION
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Eight ACTION GUIDE
    • STAR GENERATIVE RELATIONSHIPS
      • Table AG8.1 STAR Acronym Defined
      • FIGURE AG8.1 Generative STAR 1.
    • REFERENCE
      • FIGURE AG8.2 Generative STAR Worksheet Page 1.
      • FIGURE AG8.3 Generative STAR Worksheet Page 2.
• CHAPTER 9 SUPPORTING PATIENTS AND FAMILIES THROUGH PALLIATIVE CARE
  • LEARNING OBJECTIVES
  • THE NEED FOR PALLIATIVE CARE IN MODERN AMERICA
    • Table 9.1 Death in 1900 and in 2000: A Comparison
    • Table 9.2 Overarching Care Needs of Patient and Family
  • END-OF-LIFE EXPERIENCE YESTERDAY AND TODAY
    • FIGURE 9.1 Typical Trajectory of Health Status Preceding Death Before the Twentieth Century.
    • FIGURE 9.2 Typical Trajectory of Health Status Preceding Death for Chronic Illnesses with Slow Decline and Periodic Crises.
    • FIGURE 9.3 Typical Trajectory of Health Status Preceding Death for Chronic Illnesses with Steady Decline and Short Pre-Terminal Phase.
  • PRINCIPLES OF PALLIATIVE CARE
    • FIGURE 9.4 A Continuum of Care Model for Palliative Care.
  • REDUCING VARIATION IN END-OF-LIFE CARE
    • FIGURE 9.5 Total Medicare Spending for Chronically Ill Patients During the Last Two Years of Life, by State (Deaths Occurring 2001–2005).
  • CORE PROCESSES IN PALLIATIVE CARE
    • Assessing the Full Health Status and Well-Being of Patient and Family
    • Planning for the Patient and Family
    • Providing Services to Patient and Family
  • CARE COORDINATION NEAR THE END OF LIFE
    • FIGURE 9.6 Exploring the External Context of Coordinating Palliative Care.
    • FIGURE 9.7 The Palliative Care Team.
  • FORMAL PALLIATIVE CARE AND HOSPICE PROGRAMS
    • FIGURE 9.8 Disease Modifying Care, Palliative Care, and Hospice Care.
    • FIGURE 9.9 Palliative and Hospice Care Overlap.
  • PLANNING FOR BOTH LIFE AND DEATH WITH ADVANCE DIRECTIVES
  • CONCLUSION
    • Table 9.3 Activities That May Help Prevent Burnout
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Nine ACTION GUIDE
    • MENTAL MODELS
    • USING THE LADDER OF INFERENCE TO EXPLORE MENTAL MODELS
      • FIGURE AG9.1 Ladder of Inference.
      • FIGURE AG9.2 Ladder of Inference for Advocacy and Inquiry.
      • FIGURE AG9.3 Ladder of Inference Worksheet.
      • Table AG9.1 Carl's Ladder of Inference
    • REFERENCE
• CHAPTER 10 DESIGNING HEALTH SYSTEMS TO IMPROVE VALUE
  • LEARNING OBJECTIVES
  • FROM PARTS TO WHOLE
    • Table 10.1 Overarching Care Needs of Patient and Family
  • NEW VISION OF INTEGRATED SYSTEMS TO PRODUCE HIGH VALUE
    • Create Value-Based Competition
      • FIGURE 10.1 New Percutaneous Coronary Intervention.
    • Learn from Toyota to Relentlessly Reduce Waste and Continuously Add Value
    • Christensen's Use of Different Business Models to Improve Health Care Value
    • Fisher's Work to Create Accountable Care Organizations that Provide High-Value Care
    • Learn What We Need to Know
      • Lean Theory, Principles, and Methods
      • Safety Sciences and Human Factors Design
      • Performance Measurement Principles and Methods
      • Patient-Centered Design and Experience-Based Co-Design
  • THE EXECUTION TRIANGLE
    • FIGURE 10.2 A Framework for Execution.
  • LEADING CHANGE AT ALL LEVELS
    • The Process of Leading
      • Table 10.2 Tight and Loose Coupling: Features, Characteristics of Features, and Actions for Improvement
  • CHANGING LOCAL CULTURE
    • Edgar Schein's View on Changing Organizational Culture
    • Bate's Work on Organizing for Transformative Change in Health Care
      • Table 10.3 The Six Universal Challenges Facing Health Systems That Seek to Organize for Quality Health Care
      • Case Study: Leading Change in Cincinnati Children's Hospital Medical Center
        • Leading Change at All Levels at CCHMC
  • THE PATH FORWARD FOR MAKING HIGH-VALUE HEALTH SYSTEMS
    • What We Need to Do
      • FIGURE 10.3 A ligning CCHMC Microsystem Improvement with Organizational Strategic Plan.
  • SUMMARY
  • KEY TERMS
  • REVIEW QUESTIONS
  • DISCUSSION QUESTIONS
  • REFERENCES
  • Chapter Ten ACTION GUIDE
    • MICRO-, MESO-, AND MACROSYSTEM MATRIX
      • FIGURE AG10.1 Micro-Meso-Macro Framework: M3 Matrix.
• Back Matter
  • INDEX

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