The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R11
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis 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

OCR for page R11
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis      Supportiveness of the Larger System   50      Constancy of Purpose   52      Connection to Community   54      Investment in Improvement   54      Alignment of Role and Training   55     CONCLUSIONS AND DIRECTIONS FOR FURTHER RESEARCH AND POLICY   57      Limitations of This Research   57      Directions for Further Research   60      IOM Quality of Care Study   61     REFERENCES   62     APPENDIXES    A   Example of Thin and Thick Description for Quantitative Analysis   65  B   Letter of Invitation   67  C   Rosters   69  D   Pre-Interview   71  E   Telephone Interview   74 TABLE     METHODS       Stage 2:  Study Design and Data Collection    TABLE 1   Range of Micro-Systems Studied   12  TABLE 2   Micro-System Descriptions   14  TABLE 3   Question Completion Rate   18     Stage 3:  Data Analysis    TABLE 4   Micro-System Variables   20     RESULTS       I.  Case-Level Summaries by Topic    TABLE 5   Importance of Executive and Governance-level Support for Innovation and Improvement Efforts   31  TABLE 6   Importance of Strong, Focused, and Sustained Clinical Leadership   33  TABLE 7   Importance of Collaboratively Functioning Multidisciplinary Clinical Teams   35  TABLE 8   Importance of Explicit Attention to the Development of Systems of Care   37  TABLE 9A   Importance of Good Information Systems for Individual Patient Care   40  TABLE 9B   Importance of Good Information Systems for Improving Care   41  TABLE 10   Importance of a Focus on the Needs of Patients   44

OCR for page R11
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis     II.  Cross-Case Analysis—Themes Related to Effective Micro-System Performance    TABLE 11   Summary of Micro-System Framework   48  TABLE 12   Micro-System Examples of Integration of Information   49  TABLE 13   Micro-System Examples of Measurement   51  TABLE 14   Micro-System Examples of Interdependence of Care Team   52  TABLE 15   Micro-System Examples of Supportiveness of the Larger System   53  TABLE 16   Micro-System Examples of Constancy of Purpose   55  TABLE 17   Micro-System Examples of Connection to Community   56  TABLE 18   Micro-System Examples of Investment in Improvement   57  TABLE 19   Micro-System Examples of Alignment of Role and Training   59

OCR for page R11
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis This page in the original is blank.