The three cases reviewed in the first half of this chapter give rise to a set of useful tips for leaders who are guiding microsystems, mesosystems, and macrosystems in quests to provide great care (that is, care that meets patients' needs) and to minimize delays and unnecessary costs. These tips are listed in Table 9.1.
In addition to the specific tips from the case studies, we have identified four principles concerning information, information technology, data, and performance results. These principles come from our detailed qualitative analysis of our twenty high-performing clinical microsystems (Nelson et al., 2002).
Principle 1: Design It—Provide Access to a Rich Information Environment. This is the primary principle among all these principles. Information guides intelligent action. Lack of information precludes the ability to take intelligent action. Processes that support Principle 1 are
• Designing the information environment to support and inform daily work and to promote core competencies and core processes essential for care delivery
• Establishing multiple formal and informal communication channels to keep all the microsystem players—patients, families, staff—informed in a timely way
Principle 2: Connect with It—Use Information to Connect Patients to Staff and Staff to Staff. The success of the clinical microsystem is contingent on the interactions between the players—patients, clinical staff, and support staff. The players must be connected for positive and productive interactions to take place and for the right things to be done in the right way at the right time. Processes that contribute to Principle 2 are
TABLE 9.1. TIPS FOR FOSTERING A RICH INFORMATION ENVIRONMENT.
Spine Center Specialty Practice
Overlook Emergency Department
Shock Trauma Intensive Care Unit
Use full assessment of patient's health status to match the treatment plan to the patient's changing needs.
Integrate data collection and information technology into the flow of patient care delivery.
Use information technology to provide patients and staff with tailored health status data.
Use outcomes tracking over time to evaluate results of care for individual patients and for specific subpopulations of patients.
Build a clinical research infrastructure that can make use of structured data collection from patients and staff on top of a rich clinical information environment.
Use leadership, cultural patterns, and systems to make a firm foundation for technology.
Improve patient flow by visibly monitoring cycle times and key results in real time to promptly initiate needed actions.
Use comparative data to stimulate improvements in clinical processes and in patient satisfaction.
Use biomedical monitoring to provide ongoing information on the status of patients with complex, critical problems.
Use graphical and other visual data displays to connect staff to staff and staff to patients to develop optimal care plans.
Build local epidemiological knowledge, and use it to guide clinical decision making.
• Giving everyone the right information at the right time to do the work
• Investing in software, hardware, and expert staff to take full advantage of information technology to support medical care delivery
• Hearing everyone's ideas, and connecting them to benefit the patient and improve the actions that support servicing the patient
• Providing multiple channels for patients to interact with the microsystem and to receive information from the microsystem (for example, written materials, telephone calls, e-mails, Web-based information, shared medical appointments)
Principle 3: Measure It—Develop Performance Goals and Linked Measures That Reflect Primary Values and Core Competencies Essential for Providing Needed Patient Services. To improve performance or to maintain performance in the desired range of excellence, it is important to set goals that are aligned with critical values, competencies, and processes and to measure goal attainment over time. Processes that promote Principle 3 are
• Working with the microsystem team to set goals, and linking rewards and incentives to measured results
• Using measures to gauge performance, ideally in real time, in both upstream processes and downstream outcomes
Principle 4: Use It for Betterment—Measure Processes and Outcomes, Collect Feedback Data, and Redesign Continuously Based on Data. This last overarching principle completes the loop. It emphasizes using the information being gathered to provide insight to all the players, to instigate actions to improve or innovate, and to use the information streams to determine the impact of design changes. Processes that promote Principle 4 are
• Building data collection into the daily work of clinical staff and support staff
• Creating and using self-coding forms and checklists as part of work flow
• Turning the primary customer—the patient—into an information source, so that his or her interactions with the microsystem produce critical data elements in a standard or systematic manner
• Designing work processes and supporting technology to automatically throw off, or generate, important results that show how the system is working and the pattern of results that it is generating
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