fied by this study. As that study was not limited by type of health care, the goals of such a project necessitated drawing from a wide range of sites serving a variety of patient populations. It also suggests a sample size that for qualitative analytic methods was quite broad but not unwieldy. The number of sites interviewed—43—served these purposes well. We had several of each “kind” of micro-system (e.g., primary care, critical care) but they varied in location, composition, and in their own approaches to organizing and delivering care, thus providing a very rich database of observation. That report, which is expected to be published in early 2001, will use the responses and analysis described in this technical report to underpin its recommendations about how health care micro-systems, macro-systems, and other organizational forms that have not yet emerged, can improve their performance.

REFERENCES

1. Bertalanffy, Ludwig von. General System Theory.” Pp 1–10 in General Systems: Yearbook of the Society for the Advancement of General Systems Theory, 1 . Ludwig von Bertalanffy and Anatol Rapoport , eds. , 1956 .

2. Institute of Medicine . To Err is Human. Building a Safer Health System . LT Kohn , JM Corrigan , MS Donaldson , eds . Washington, DC : National Academy Press , 2000 .

3. Scott, Richard W. Organizations: Rational, Natural, and Open Systems . Englewood Cliffs, NJ : Prentice Hall , 1981 .

4. Boulding, Kenneth. General Systems Theory: The Skeleton of Science . Management Science 2 : 197–208 , 1956 .

5. Quinn , James B. Intelligent Enterprise . New York : Free Press , 1992 .

6. Frontiers of Health Services Management 15(1) , 1998 , passim .

7. Nelson , Eugene C. , Batalden , Paul B. , Mohr , Julie J. , et al . Building a Quality Future . Frontiers of Health Services Management 15 : 3–32 , 1998 .

8. Nelson , Eugene C. , Batalden , Paul B. , Mohr Julie J. , et al . “Building a Quality Future.” Frontiers of Health Services Management 15 : 3–32 , 1998 .

9. Kaluzny , Arnold D. “Design and Management of Disciplinary and Interdisciplinary Groups in Health Services: Review and Critique.” Medical Care Review 42(1) : 77–112 , 1985 .

10. Cebul , Randall D. “Randomized, Controlled Trials Using the Metro Firm System.” Medical Care 29 : JS9–JS18 , 1991 .

11. Neuhauser , Duncan. “Parallel Providers, Ongoing Randomization, and Continuous Improvement. ” Medical Care 29 : JS5–JS8 , 1991 .

12. Neuhauser , Duncan. “Progress on Firms Research.” International Journal of Technology Assessment_in Health Care 8 : 321–324 , 1992 .

13. Patton , Michael Q. Qualitative Evaluation and Research Methods . Newbury Park : Sage Publications , 1994 .

14. Center for the Evaluative Clinical Sciences . Dartmouth Medical School . The Quality of Medical Care in the United States: A Report on the Medicare Program . Dartmouth Atlas of Helath Care, 1999 .

15. Guba , Egon G. Toward a Methodology of Naturalistic Inquiry in Educational Evaluation . Los Angeles , University of California , Los Angeles , Center for the Study of Evaluation , 1978 .

16. Guba , Egon G. and Lincoln, Yvonna S . Effective Evaluation: Improving the Usefulness of Evaluation Results Through Responsive and Naturalistic Approaches . San Francisco , JosseyBass , 1981 .

17. Denzin , Norman K. Interpretive Interactionism . Newbury Park , Sage Publications , 1989 .

18. Patton , Michael Q. Qualitative Evaluation and Research Methods . Newbury Park : Sage Publications , 1994 .



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Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis fied by this study. As that study was not limited by type of health care, the goals of such a project necessitated drawing from a wide range of sites serving a variety of patient populations. It also suggests a sample size that for qualitative analytic methods was quite broad but not unwieldy. The number of sites interviewed—43—served these purposes well. We had several of each “kind” of micro-system (e.g., primary care, critical care) but they varied in location, composition, and in their own approaches to organizing and delivering care, thus providing a very rich database of observation. That report, which is expected to be published in early 2001, will use the responses and analysis described in this technical report to underpin its recommendations about how health care micro-systems, macro-systems, and other organizational forms that have not yet emerged, can improve their performance. REFERENCES 1. Bertalanffy, Ludwig von. General System Theory.” Pp 1–10 in General Systems: Yearbook of the Society for the Advancement of General Systems Theory, 1 . Ludwig von Bertalanffy and Anatol Rapoport , eds. , 1956 . 2. Institute of Medicine . To Err is Human. Building a Safer Health System . LT Kohn , JM Corrigan , MS Donaldson , eds . Washington, DC : National Academy Press , 2000 . 3. Scott, Richard W. Organizations: Rational, Natural, and Open Systems . Englewood Cliffs, NJ : Prentice Hall , 1981 . 4. Boulding, Kenneth. General Systems Theory: The Skeleton of Science . Management Science 2 : 197–208 , 1956 . 5. Quinn , James B. Intelligent Enterprise . New York : Free Press , 1992 . 6. Frontiers of Health Services Management 15(1) , 1998 , passim . 7. Nelson , Eugene C. , Batalden , Paul B. , Mohr , Julie J. , et al . Building a Quality Future . Frontiers of Health Services Management 15 : 3–32 , 1998 . 8. Nelson , Eugene C. , Batalden , Paul B. , Mohr Julie J. , et al . “Building a Quality Future.” Frontiers of Health Services Management 15 : 3–32 , 1998 . 9. Kaluzny , Arnold D. “Design and Management of Disciplinary and Interdisciplinary Groups in Health Services: Review and Critique.” Medical Care Review 42(1) : 77–112 , 1985 . 10. Cebul , Randall D. “Randomized, Controlled Trials Using the Metro Firm System.” Medical Care 29 : JS9–JS18 , 1991 . 11. Neuhauser , Duncan. “Parallel Providers, Ongoing Randomization, and Continuous Improvement. ” Medical Care 29 : JS5–JS8 , 1991 . 12. Neuhauser , Duncan. “Progress on Firms Research.” International Journal of Technology Assessment_in Health Care 8 : 321–324 , 1992 . 13. Patton , Michael Q. Qualitative Evaluation and Research Methods . Newbury Park : Sage Publications , 1994 . 14. Center for the Evaluative Clinical Sciences . Dartmouth Medical School . The Quality of Medical Care in the United States: A Report on the Medicare Program . Dartmouth Atlas of Helath Care, 1999 . 15. Guba , Egon G. Toward a Methodology of Naturalistic Inquiry in Educational Evaluation . Los Angeles , University of California , Los Angeles , Center for the Study of Evaluation , 1978 . 16. Guba , Egon G. and Lincoln, Yvonna S . Effective Evaluation: Improving the Usefulness of Evaluation Results Through Responsive and Naturalistic Approaches . San Francisco , JosseyBass , 1981 . 17. Denzin , Norman K. Interpretive Interactionism . Newbury Park , Sage Publications , 1989 . 18. Patton , Michael Q. Qualitative Evaluation and Research Methods . Newbury Park : Sage Publications , 1994 .

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Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis 19. Geertz , Clifford . The Interpretation of Cultures . New York , Basic Books , 1973 . 20. Denzin , Norman K. Interpretive Interactionism . Newbury Park , Sage Publications , 1989 . 21. Patton , Michael. Q. Qualitative Evaluation and Research Methods . Newbury Park : Sage Publications , 1994 . 22. Miles , Mathew B. and A. Michael . Huberman . An Expanded Sourcebook: Qualitative Data Analysis . Thousand Oaks , London , Sage Publications , 1994 . 23. Ragin , Charles C. The Comparative Method: Moving Beyond Qualitative and Quantitative Strategies . Berkeley , University of California Press , 1987 . 24. Miles , Mathew B. and A. Michael. Huberman . An Expanded Sourcebook: Qualitative Data Analysis . Thousand Oaks , London , Sage Publications , 1994 . 25. Miles , Mathew B. and A. Michael. Huberman . An Expanded Sourcebook: Qualitative Data Analysis . Thousand Oaks , London , Sage Publications , 1994 . 26. Miles , Mathew. B. and A. Michael. Huberman . An Expanded Sourcebook: Qualitative Data Analysis . Thousand Oaks , London , Sage Publications , 1994 . 27. Rogers , Everett M. Diffusion of Innovations . New York , Free Press , 1995 . 28. Institute of Medicine . To Err is Human . Building a Safer Health System . LT Kohn , JM Corrigan , MS Donaldson , eds . Washington, DC : National Academy Press , 2000 . 29. Blumenthal , David and Kilo , Charles M. A Report Card on Continuous Quality Improvement . Milbank Q 76 : 625–648 , 1998 . 30. Shortell , Stephen M. , Bennett , Charles L. , and Byck , Gayle . Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress . Milbank Q 76 : 593–624 , 1998 . 31. Patton , Michael. Q. Qualitative Evaluation and Research Methods . Newbury Park : Sage Publications , 1994 . 32. Eysenbach , Gunther. Consumer Health Informatics . BMJ 320 : 1713–1716 , 2000 .

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