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