About the Book
The latest edition of the bestselling text on quality improvement in health care, providing powerful theoretical frameworks and principles, valuable tools and techniques, and a proven action-learning program
Now in its second edition, Quality By Design contains an evidence and practice based strategy for teaching and practicing the clinical microsystem approach across all levels of health care organizations. Overall, the microsystem approach continues to evolve and adapt to meet the changing needs of healthcare organizations. Ongoing research, the development of updated models, and innovative applications across diverse settings demonstrate the approach’s potential to transform healthcare delivery and improve outcomes for patients and staff alike.
This innovative volume provides research and practical results based on the original high-performing clinical microsystems research conducted at The Dartmouth Institute for Health Policy and Clinical Practice. Quality By Design, Second Edition, advances clinical microsystem theory and practice with new material and updates:
New in the Second Edition:
Global Impact: The microsystem approach has gained traction internationally, with healthcare organizations and universities in various countries successfully adapting and implementing the approach in specific healthcare cultural and contextual nuances. Real-world case studies showcase the microsystem approach’s success across diverse healthcare settings.
Patient-Centered Care: Emphasis on coproduction of care, where patients and families are active partners in improvement
Meeting Standards: Guidance on using the microsystem framework including effective meeting skills to ensure productivity and value of meetings.
Team Coaching: Team Coaching case studies demonstrate its effectiveness in empowering frontline teams and improving their capabilities. Simultaneously, insights into multi-level leadership guide horizontal and vertical integration efforts for organizational success.
Workforce Development and Well-being: Updated strategies for interprofessional education and development early in a career and throughout a career to learn to provide care and improve care is included
System-Wide Improvement: New models and insights underscores the importance of integrating micro, meso, and macro systems to create a cohesive and efficient healthcare system. This involves aligning goals, processes, and communication across different levels of the organization.
Data-Driven Decision Making: Strategies for building information-rich environments and leveraging data at all levels including key measurement and change management techniques.
Patient Safety and Reliability: A personal case study offers a fresh perspective on error prevention and improving reliability
Action Guide: An updated guide to accelerating improvement in clinical mesosystems.
Remember: Successful implementation of the microsystem approach requires a long-term commitment to continuous learning, collaboration, and adaptation. By fostering a culture of improvement and empowering staff at all levels, organizations can harness the power of microsystems to achieve their quality and safety goals.
This expanded edition solidifies Quality by Design as an indispensable resource for anyone committed to transforming healthcare through the power of microsystems.
Table of Contents:
Tables, Figures, and Exhibits xiii
Foreword xxi
Preface xxv
Acknowledgments xxix
The Editors xxxiii
The Contributors xxxix
Introduction xli
1 Clinical Microsystems – Success Characteristics of High-Performing Microsystems 1
Julie K. Johnson, Marjorie M. Godfrey, Boel Andersson- Gäre, Susanne Kvarnström, Tina C. Foster
2 Developing High-Performing Microsystems 37
Marjorie M. Godfrey, Tina C. Foster, Steve Harrison, Martin J. Wildman, Julie K. Johnson
3 Leading Improvement of Healthcare Service Systems: Microsystems, Mesosystems, and Macrosystems 71
Paul B. Batalden, Edgar H. Schein, Don Caruso, Marjorie M. Godfrey, Tina C. Foster, Julie K. Johnson
4 Developing Professionals and Improving Work Life 111
Marjorie M. Godfrey, Tina C. Foster, Gay L. Landstrom, Joan Clifford, Julie K. Johnson
5 Transforming a Primary Care Clinic to an NCQA- Certified Patient- Centered Medical Home 145
Marjorie M. Godfrey, Tina C. Foster, Randy Messier, Julie K. Johnson
6 Partnership within the Clinical Microsystem’s Framework: Coproducing Good Outcomes with Patients and Families 189
Maren Batalden, Julie K. Johnson, Cristin Lind, Helena Hvitfeldt, Paul B. Batalden, Tina C. Foster, Marjorie M. Godfrey
7 Improving Patient Safety and Reliability 217
Julie K. Johnson, Paul R. Barach, Gautham K. Suresh, Tanya Lord, Marjorie M. Godfrey, Tina C. Foster
8 Creating an Actionable Healthcare Information Environment to Inform Intelligent Action 251
Brant J. Oliver, Eugene C. Nelson, John N. Mecchella, AnnMarie R. Hess, Marjorie M. Godfrey, Tina C. Foster, Julie K. Johnson
9 Interprofessional Education and the Clinical Microsystem 299
Tina C. Foster, Paul N. Uhlig, Brant J. Oliver, Gay L. Landstrom, Julie K. Johnson, Marjorie M. Godfrey
10 The New Frontier of System Improvement – Mesosystems 333
Marjorie M. Godfrey, Tom Downes, Steve Harrison, Julie K. Johnson, Tina C. Foster
Afterword 367
Appendix: Accelerating Improvement in Clinical Mesosystems 375
Glossary 477
Name Index 495
Subject Index 501
About the Author :
Marjorie M. Godfrey, PhD, MS, BSN, FAAN, Founding Executive Director, the Institute for Excellence in Health and Social Systems, Research Professor, Department of Nursing, University of New Hampshire. Affiliate Professor Jönköping University, Jönköping Sweden. Previously Founding Co-Director Dartmouth Institute Microsystem Academy, Geisel School of Medicine, Dartmouth College.
Tina C. Foster, MD, MPH, MSc, Professor of Obstetrics and Gynecology, Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Professor of The Dartmouth Institute, Geisel School of Medicine at Dartmouth. Previously Co-Director Dartmouth Institute Microsystem Academy, Geisel School of Medicine, Dartmouth College.
Julie K. Johnson, MSPH, PhD, Professor Department of Surgery and Center for Healthcare Studies Northwestern University
Eugene C. Nelson, DSc, MPH, Professor of Community and Family Medicine, Geisel School of Medicine at Dartmouth, and The Dartmouth Institute for Health Policy and Clinical Practice. Director of Population Health and Measurement, The Dartmouth Institute.
Paul B. Batalden, MD, Professor Emeritus, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College.
