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Suggested Citation:"Introduction." Institute of Medicine. 2000. Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis. Washington, DC: The National Academies Press. doi: 10.17226/10096.
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Contents ABSTRACT......................................................................................................................... v INTRODUCTION............................................................................................................... 1 BACKGROUND ................................................................................................................. 2 Defining Health Care Micro-Systems 3 Use of Qualitative Methods 5 METHODS.......................................................................................................................... 8 Stage 1: Literature Review, Nomenclature, and Study Design 8 Operational Definition 9 Stage 2: Study Design and Data Collection 9 Instrument and Protocol Development 9 Site Selection 11 Instrument Testing and Interviewer Reliability 11 Data Collection 13 Stage 3: Data Analysis 19 Case-Level Summary Analysis of Health Care Micro-Systems 19 Cross-Case Analysis 20 RESULTS .......................................................................................................................... 21 I. Case-Level Summaries by Topic 21 Level of Performance 21 Patient Experience 23 Information and Information Technology 25 Improvement 26 Leadership and Management: Lessons for Replication 28 II. Cross-Case Analysis—Themes Related to Effective Micro-System Performance 47 Integration of Information 47 Measurement 47 Interdependence of the Care Team Members 50 xi

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Exploring Innovation and Quality Improvement in Health Care Micro-Systems defines and describes health care micro-systems and analyzes 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 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.

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