Quality by Design reflects the research and applied training conducted at Dartmouth Medical School under the leadership of Gene Nelson, Paul Batalden, and Marjorie Godfrey. The book includes the research results of high-performing clinical microsystems, illustrative case studies that highlight individual clinical programs, guiding principles that are easily applied, and tools, techniques, and methods that can be adapted by clinical practices and interdisciplinary clinical teams.

The authors describe how to develop microsystems that can attain peak performance through active engagement of interdisciplinary teams in learning and applying improvement science and measurement; explore the essence of leadership for clinical Microsystems; show what mid-level leaders can do to enable peak performance at the front lines of care; outline the design and redesign of services and planning care to match patient needs with services offered; examine the issue of safety; describe the vital role of data in creating a rich and useful information environment; provide a core curriculum that can build microsystems’ capability, provide excellent care, promote a positive work environment, and contribute to the larger organization.

Table of Contents

List of Tables, Figures, and Exhibits

Foreword by Donald M. Berwick

Preface

Acknowledgments

Introduction

The Editors

The Contributors

PART ONE: CASES AND PRINCIPLES

Success Characteristics of High-Performing Microsystems: Learning from the Best (Eugene C. Nelson, Paul B. Batalden, Thomas P. Huber, Julie K. Johnson, Marjorie M. Godfrey, Linda A. Headrick,and John H. Wasson)

Developing High-Performing Microsystems (Eugene C. Nelson, Paul B. Batalden, William H. Edwards, Marjorie M. Godfrey, and Julie K. Johnson)

Leading Microsystems (Paul B. Batalden, Eugene C. Nelson, Julie K. Johnson, Marjorie M. Godfrey, Thomas P. Huber, Linda Kosnik, and Kerri Ashling)

Leading Macrosystems and Mesosystems for Microsystem Peak Performance (Paul B. Batalden, Eugene C. Nelson, Paul B. Gardent, and Marjorie M. Godfrey)

Developing Professionals and Improving Worklife (Thomas P. Huber, Marjorie M. Godfrey, Eugene C. Nelson, Julie K. Johnson, Christine Campbell, and Paul B. Batalden)

Planning Patient-Centered Services (Marjorie M. Godfrey, Eugene C. Nelson, John H. Wasson, Julie K. Johnson, and Paul B. Batalden)

Planning Patient-Centered Care (John H. Wasson, Marjorie M. Godfrey, Eugene C. Nelson, Julie K. Johnson, and Paul B. Batalden)

Improving Patient Safety (Julie K. Johnson, Paul Barach, Joseph P. Cravero, George T. Blike, Marjorie M. Godfrey, Paul B. Batalden, and Eugene C. Nelson)

Creating a Rich Information Environment (Eugene C. Nelson, Paul B. Batalden, Karen Homa, Marjorie M. Godfrey, Christine Campbell, Linda A. Headrick, Thomas P. Huber, Julie K. Johnson, and John H. Wasson)

PART TWO: ACTIVATING THE ORGANIZATION AND THE DARTMOUTH MICROSYSTEM IMPROVEMENT CURRICULUM

Overview of Path Forward and Introduction to Part Two

Introduction to Microsystem Thinking

Effective Meeting Skills I

Assessing Your Microsystem with the 5 P’s

The Model for Improvement: PDSA!!

Selecting Themes for Improvement

Improvement Global Aim

Process Mapping

Specific Aim

Cause and Effect Diagrams

Effective Meeting Skills II: Brainstorming and Multi-Voting

Change Concepts

Measurement and Monitoring

Action Plans and Gantt Charts

Follow Through on Improvement: Storyboards, Data Walls, and Playbooks

Conclusion: Continuing on the Path to Excellence

Appendix A: Primary Care Workbook

Name Index

Subject Index

Author Information

Eugene C. Nelson, D.Sc., M.P.H., is director of quality administration for the Dartmouth-Hitchcock Medical Center and professor of community and family medicine at Dartmouth Medical School.

Paul B. Batalden, M.D. is the director of health care improvement leadership development, Center for the Evaluative Clinical Sciences, and professor of pediatrics and of community and family medicine at Dartmouth Medical School.

Marjorie M. Godfrey, M.S., R.N., is instructor for community and family medicine at and director of the Clinical Microsystem Resource Group at Dartmouth Medical School.