Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis

INTRODUCTION

This is the final report to The Robert Wood Johnson Foundation on the study methods, findings, and conclusions of grant number 36222 to the Institute of Medicine (IOM) to assist its Committee on the Quality of Health Care in America (QHCA). One objective for the IOM committee was the identification of key characteristics and factors that enable or encourage providers, health care organizations, health plans and communities to continuously improve the quality of care. To advance its work, a subcommittee of QHCA, the Subcommittee on Building the 21st Century Health System, used the micro-systems study as an opportunity to use the empirical findings from structured interviews to guide its deliberations and to increase its understanding of exemplary health care delivery systems.

Specifically, the tasks set out for the study and described in this report were:

  • to define and describe health care micro-systems; and

  • to analyze characteristics that enable specific micro-systems to improve the quality of care provided to their patient populations.

This study reports on structured interviews used to collect primary data (summer, 1999) from 43 micro-systems providing primary and specialty care, hospice, emergency, and critical care. It summarizes responses to the interviews about how micro-systems function, what they know about their level of performance, how they improve care, the leadership needed, the barriers they have encountered, and how they have dealt with these barriers. Analysis includes, first, summary description of each interview topic, including a section on lessons for replication identified by respondents that may point the way toward replication of the work of these micro-systems. Second, the analysis includes eight themes that emerged from the cross-case analysis of the interviews. These themes provide a framework for thinking about how health care micro-systems function. It is possible that the most effective micro-systems will be able to demonstrate a high level of performance in each of these areas. The study also identifies directions for further research that could contribute to designing and redesigning delivery systems, improving care, preparing future health professionals, and formulating health policy.



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Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis INTRODUCTION This is the final report to The Robert Wood Johnson Foundation on the study methods, findings, and conclusions of grant number 36222 to the Institute of Medicine (IOM) to assist its Committee on the Quality of Health Care in America (QHCA). One objective for the IOM committee was the identification of key characteristics and factors that enable or encourage providers, health care organizations, health plans and communities to continuously improve the quality of care. To advance its work, a subcommittee of QHCA, the Subcommittee on Building the 21st Century Health System, used the micro-systems study as an opportunity to use the empirical findings from structured interviews to guide its deliberations and to increase its understanding of exemplary health care delivery systems. Specifically, the tasks set out for the study and described in this report were: to define and describe health care micro-systems; and to analyze characteristics that enable specific micro-systems to improve the quality of care provided to their patient populations. This study reports on structured interviews used to collect primary data (summer, 1999) from 43 micro-systems providing primary and specialty care, hospice, emergency, and critical care. It summarizes responses to the interviews about how micro-systems function, what they know about their level of performance, how they improve care, the leadership needed, the barriers they have encountered, and how they have dealt with these barriers. Analysis includes, first, summary description of each interview topic, including a section on lessons for replication identified by respondents that may point the way toward replication of the work of these micro-systems. Second, the analysis includes eight themes that emerged from the cross-case analysis of the interviews. These themes provide a framework for thinking about how health care micro-systems function. It is possible that the most effective micro-systems will be able to demonstrate a high level of performance in each of these areas. The study also identifies directions for further research that could contribute to designing and redesigning delivery systems, improving care, preparing future health professionals, and formulating health policy.