Quality By Design: A Clinical Microsystems Approach
Author: Eugene C Nelson
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:
Tables, Figures, and Exhibits xiiiForeword Donald M. Berwick xix
Preface xxiii
Acknowledgments xxvii
Introduction xxxi
The Editors xxxix
The Contributors xliii
Cases and Principles 1
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 John H. Wasson 3
True Structure of the System, Embedded Systems, and Need to Transform Frontline Systems
The Bladyka Case
Research Design
Results
Practical Implications
Conclusion
Developing High-Performing Microsystems Eugene C. Nelson Paul B. Batalden William H. Edwards Marjorie M. Godfrey Julie K. Johnson 34
Case Study: A Decade of Progress for an Intensive Care Nursery
A Model of Development and a Curriculum to Catalyze Microsystem Growth
Conclusion
Leading Microsystems Paul B. Batalden Eugene C. Nelson Julie K. Johnson Marjorie M. Godfrey Thomas P. Huber Linda Kosnik Kerri Ashling 51
Leader, Leadership,Leading
Recap of Methods
Three Fundamental Processes of Leading: What Clinical Microsystem Team Members Observe and Report
Discussion
Conclusion
Leading Macrosystems and Mesosystems for Microsystem Peak Performance Paul B. Batalden Eugene C. Nelson Paul B. Gardent Marjorie M. Godfrey 69
Case Study: A True Story, with Names Changed to Protect the Innocent
Leadership Frameworks: Some of the Best Approaches
Leading Large Health Systems to Peak Performance Using Microsystem Thinking
Conclusion
Developing Professionals and Improving Worklife Thomas P. Huber Marjorie M. Godfrey Eugene C. Nelson Julie K. Johnson Christine Campbell Paul B. Batalden 106
Case Study: Staff Development at Massachusetts General Hospital Downtown Associates
Conclusion
Planning Patient-Centered Services Marjorie M. Godfrey Eugene C. Nelson John H. Wasson Julie K. Johnson Paul B. Batalden 124
Planning Patient-Centered Services and the 5 P's
Case Study: Planning Services for Subpopulations of Patients to Best Provide Care for Individual Patients
A Developmental Journey: Beginning to Assess, Understand, and Improve a Clinical Microsystem
Analysis and Improvement of Processes
A Huddle in Plastic Surgery
Conclusion
Planning Patient-Centered Care John H. Wasson Marjorie M. Godfrey Eugene C. Nelson Julie K. Johnson Paul B. Batalden 148
Planning Care Well: Exemplary Clinical Microsystems
Planning Care in Any Microsystem
A Low-Tech Example for Ambulatory Services: Care Vital Signs
Conclusion
Improving Patient Safety Julie K. Johnson Paul Barach Joseph P. Cravero George T. Blike Marjorie M. Godfrey Paul B. Batalden Eugene C. Nelson 165
Microsystem Patient Safety Scenario
Case Study: Dartmouth-Hitchcock PainFree Program
Conclusion
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 John H. Wasson 178
Specialty Care: Dartmouth-Hitchcock Spine Center
Overlook Hospital Emergency Department
Intermountain Health Care Shock Trauma Intensive Care Unit
Tips and Principles to Foster a Rich Information Environment
Discussion
Conclusion
Activating the Organization and the Dartmouth Microsystem Improvement Curriculum 197
Overview of Path Forward and Introduction to Part Two 199
Recap of Part One and Overview of Part Two
Using Real Case Studies and Practical Applications of Microsystem Thinking, Methods, and Tools
Working at All Levels of a Health System
Focusing on the Microsystem Level
Review Questions
Prework
Introduction to Microsystem Thinking 230
What Is a System in Health Care?
How Did Clinical Microsystem Knowledge Evolve?
What Is a Clinical Microsystem?
Where Do Clinical Microsystems Fit in the Health Care Delivery System?
What Does a Clinical Microsystem Look Like?
Why Focus on the Clinical Microsystem?
How Do Clinical Microsystems Link to Crossing the Quality Chasm?
What Were the Findings of the Dartmouth Clinical Microsystem Research?
What Does a Microsystem's Developmental Journey Look Like?
Conclusion
Case Studies
Review Questions
Between Sessions Work
Effective Meeting Skills I 243
What Is a Productive and Effective Meeting?
Why Use Meeting Skills and Roles?
What Are Effective Meeting Roles?
What Are the Phases of an Effective Meeting?
What Processes Are Evident in an Effective Meeting?
What Is the Seven-Step Meeting Process?
What Does a Meeting Agenda Template Look Like?
What Are the Ground Rules for Meetings?
What Are Some Tips for Getting Started with Productive Meetings?
How Do You Keep a Rhythm of Improvement?
Case Studies
Review Questions
Between Sessions Work
Assessing Your Microsystem with the 5 P's 258
How Does an Interdisciplinary Lead Improvement Team Begin to Assess and Improve a Clinical Microsystem?
What Does the 5 P's Framework Look Like?
What Resources Are Available to Guide the 5 P's Assessment?
What Is a Helpful Way to Introduce Your Team to the Assessment Process?
What Are the 5 P's?
What Should You Do with the Assessment Findings?
Case Studies
Review Questions
Between Sessions Work
The Model for Improvement: PDSA [leftrightarrow] SDSA 271
What Is the Model for Improvement?
Why Use the Model for Improvement?
How Does the Model Fit into the Improvement Process?
What Is the PDSA Part of the Model?
What Are the Benefits of Using PDSA?
What Is Involved in Each of the Four Steps of Plan, Do, Study, and Act?
What Is the SDSA Cycle?
What Is Involved in Each of the Four Steps of Standardize, Do, Study, and Act?
What Tools Can Assist Your PDSA Cycle [leftrightarrow] SDSA Implementation?
What Are Some Tips for Using the PDSA [leftrightarrow] SDSA Method?
Case Studies
Review Questions
Between Sessions Work
Selecting Themes for Improvement 284
What Is a Theme for Improvement?
Why Use a Theme?
What Are the Theme Selection Considerations?
What Process Can You Use to Generate Theme Ideas and Select a First Theme?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Improvement Global Aim 291
What Is a Global Aim?
Why Use a Global Aim?
How Do You Write a Global Aim?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Process Mapping 296
What Is Process Mapping?
Why Use Process Mapping?
What Are the Commonly Used Flowchart Symbols?
What Does a High-Level Flowchart Look Like?
What Does a Detailed Flowchart Look Like?
What Are Some Tips for Creating a Flowchart?
What Does a Deployment Flowchart Look Like?
What Are Some Tips for Creating a Deployment Flowchart?
Case Studies
Review Questions
Between Sessions Work
Specific Aim 308
What Is a Specific Aim?
Why Use a Specific Aim?
Where Do Specific Aims Come From?
Where Does the Specific Aim Fit in the Overall Improvement Process?
How Do You Write a Specific Aim?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Cause and Effect Diagrams 313
What Is a Cause and Effect Diagram?
Why Use a Fishbone Diagram?
What Is the Structure of a Fishbone Diagram?
What Does a Completed Fishbone Look Like?
What Are Some Tips for Creating a Fishbone Diagram?
Case Studies
Review Questions
Between Sessions Work
Effective Meeting Skills II: Brainstorming and Multi-Voting 321
What Is Brainstorming?
What Are the Benefits of Brainstorming?
What Are Some Different Types of Brainstorming?
What Are Some Tips for Conducting Brainstorming?
What Is Multi-Voting?
Do Teams Always Multi-Vote After a Brainstorming Session?
How Do You Multi-Vote?
What Does a Brainstorming Session with a Multi-Voting Outcome Look Like?
Case Studies
Review Questions
Between Sessions Work
Change Concepts 331
What Is a Change Concept?
Why Use Change Concepts?
How Can You Use Change Concepts in a Process?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Measurement and Monitoring 339
What Are Measures, What Makes Measures Good, and How Do They Relate to Aims?
What Is a Run Chart?
What Are the Benefits of Using a Run Chart?
How Do Run Charts Fit in the Overall Improvement Process?
What Do Run Charts Tell You About Your Performance Level and Variation?
What Are Special Cause and Common Cause Variation?
How Do You Make a Run Chart?
How Do You Interpret Run Chart Results?
What Is a Control Chart?
What Is the Theory Behind Control Charts?
What Are the Benefits of Using a Control Chart Instead of a Run Chart?
What Are the Different Kinds of Control Charts?
What Is an XmR Control Chart?
How Do You Interpret Control Chart Results?
When Do You Recalculate Control Chart Values?
What Are Some Tips for Using Run Charts and Control Charts?
Case Studies
Review Questions
Between Sessions Work
Action Plans and Gantt Charts 362
What Is an Action Plan?
What Is a Gantt Chart?
Why Use Action Plans and Gantt Charts?
How Do You Write an Action Plan?
How Do You Create a Gantt Chart?
What Are the Next Steps?
Case Studies
Review Questions
Between Sessions Work
Follow Through on Improvement: Storyboards, Data Walls, and Playbooks 369
What Is the Importance of Follow Through?
What Can You Do to Follow Through?
What Are the Fundamentals of Improvement?
What Is a Data Wall?
What Is a Playbook?
How Is the Playbook Used?
How Do You Create a Playbook?
How Do You Maintain Your Playbook?
What Is a Storyboard?
How Do You Make a Storyboard?
Discussion
Case Studies
Review Questions
Between Sessions Work
Conclusion: Continuing on the Path to Excellence 380
Looking Back
Looking Forward and an Invitation: Make It Personal and Make It Happen
Primary Care Workbook 385
Name Index 433
Subject Index 437
See also: House of Mondavi or The All New Ultimate Southern Living Cookbook
Advances in Behavioral Finance
Author: Richard H Thaler
This book offers a definitive and wide-ranging overview of developments in behavioral finance over the past ten years. In 1993, the first volume provided the standard reference to this new approach in finance--an approach that, as editor Richard Thaler put it, "entertains the possibility that some of the agents in the economy behave less than fully rationally some of the time." Much has changed since then. Not least, the bursting of the Internet bubble and the subsequent market decline further demonstrated that financial markets often fail to behave as they would if trading were truly dominated by the fully rational investors who populate financial theories. Behavioral finance has made an indelible mark on areas from asset pricing to individual investor behavior to corporate finance, and continues to see exciting empirical and theoretical advances.
Advances in Behavioral Finance, Volume II constitutes the essential new resource in the field. It presents twenty recent papers by leading specialists that illustrate the abiding power of behavioral finance--of how specific departures from fully rational decision making by individual market agents can provide explanations of otherwise puzzling market phenomena. As with the first volume, it reaches beyond the world of finance to suggest, powerfully, the importance of pursuing behavioral approaches to other areas of economic life.
The contributors are Brad M. Barber, Nicholas Barberis, Shlomo Benartzi, John Y. Campbell, Emil M. Dabora, Daniel Kent, François Degeorge, Kenneth A. Froot, J. B. Heaton, David Hirshleifer, Harrison Hong, Ming Huang, Narasimhan Jegadeesh, Josef Lakonishok, Owen A. Lamont, Roni Michaely,Terrance Odean, Jayendu Patel, Tano Santos, Andrei Shleifer, Robert J. Shiller, Jeremy C. Stein, Avanidhar Subrahmanyam, Richard H. Thaler, Sheridan Titman, Robert W. Vishny, Kent L. Womack, and Richard Zeckhauser.
Booknews
A collection of 21 recent articles that illustrate the power of a new approach to finance, one which as editor Thaler puts it, "entertains the possibility that some of the agents in the economy behave less than fully rationally some of the time." These papers illustrate how specific departures from fully rational decisionmaking by individual market agents can provide explanations of otherwise puzzling market phenomena. Annotation c. Book News, Inc., Portland, OR (booknews.com)
Table of Contents:
| Preface | ||
| Ch. 1 | A survey of behavioral finance | 1 |
| Ch. 2 | The limits of arbitrage | 79 |
| Ch. 3 | How are stock prices affected by the location of trade? | 102 |
| Ch. 4 | Can the market add and subtract? : mispricing in tech stock carve-outs | 130 |
| Ch. 5 | Valuation ratios and the long-run stock market outlook : an update | 173 |
| Ch. 6 | Myopic loss aversion and the equity premium puzzle | 202 |
| Ch. 7 | Prospect theory and asset prices | 224 |
| Ch. 8 | Contrarian investment, extrapolation, and risk | 273 |
| Ch. 9 | Evidence on the characteristics of cross-sectional variation in stock returns | 317 |
| Ch. 10 | Momentum | 353 |
| Ch. 11 | Market efficiency and biases in brokerage recommendations | 389 |
| Ch. 12 | A model of investor sentiment | 423 |
| Ch. 13 | Investor psychology and security market under- and overreaction | 460 |
| Ch. 14 | A unified theory of underreaction, momentum trading, and overreaction in asset markets | 502 |
| Ch. 15 | Individual investors | 543 |
| Ch. 16 | Naive diversification strategies in defined contribution savings plans | 570 |
| Ch. 17 | Rational capital budgeting in an irrational world | 605 |
| Ch. 18 | Earnings management to exceed thresholds | 633 |
| Ch. 19 | Managerial optimism and corporate finance | 667 |
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