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Fundamentals of Health Care Improvement: A Guide to Improving Your Patients\' Care, Fifth Edition, 2025
- Fundamentals of Health Care Improvement [Go to Page]
- Joint Commission Mission
- Disclaimers
- Development Team
- Joint Commission Reviewers
- Table of Contents
- Dedications
- Foreword from Joint Commission
- Foreword from Institute for Healthcare Improvement
- Access to the Digital Tools in This Book
- Introduction [Go to Page]
- Overview of Contents [Go to Page]
- Chapter 1: Identifying Gaps in Quality and Working in Teams to Close Those Gaps
- Chapter 2: The Forgotten Aim
- Chapter 3: Finding Scientific Evidence for Clinical Improvement
- Chapter 4: Identifying a Focus for Improvement
- Chapter 5: Process Literacy, Context, Culture, and Systems in Health Care
- Chapter 6: Measurement Part 1: Data Analysis for Decision-Making in Health Care
- Chapter 7: Measurement Part 2: Using Run Charts and Statistical Process Control Charts to Gain Insight into Systems
- Chapter 8: Understanding and Making Changes in a System
- Chapter 9: Spreading Improvements
- Chapter 10: Publishing and Presenting Quality Improvement
- Appendix: Tools to Help Your Improvement Work
- About the Authors [Go to Page]
- About the Foreword Authors
- Acknowledgments
- CHAPTER 01 Identifying Gaps in Quality and Working in Teams to Close Those Gaps [Go to Page]
- Diagnosing an individual
- Diagnosing a System
- Finding the Quality Gap
- Evidence-Based improvement [Go to Page]
- The Missing Connector
- Caring for a System
- Describing improvement Methods [Go to Page]
- Relationships Among the Pillars
- Triple, Quadruple, and Quintuple Aim
- interprofessional Teams for improvement [Go to Page]
- Improvement Teams [Go to Page]
- System leader
- Team members
- Executive sponsor
- Patients and family members
- The Model for improvement [Go to Page]
- Three Questions in the Model for Improvement
- Summary [Go to Page]
- BRIDGING GAPS IN IMPROVEMENT [Go to Page]
- Quality Improvement Programs
- Six Sigma
- Lean
- Lean Six Sigma
- Robust Process Improvement® (RPI)®
- Study Questions [Go to Page]
- References
- CHAPTER 02 The Forgotten Aim [Go to Page]
- The Quality Chasm
- Overview: Health Equity and Health inequity [Go to Page]
- Social Drivers of Health: Upstream and Downstream Influences
- Global Perspectives on Health Inequities
- Why Health Equity Matters to Quality improvement Practitioners [Go to Page]
- Integrating Equity into Quality Improvement Practice [Go to Page]
- The Foundation for Equity-Focused Quality Improvement
- Equity-Related Concepts and Theories: Key Definitions
- Power, Privilege, and Bias in Health Care [Go to Page]
- Using the Wheel of Privilege and Power
- Improvement Opportunity, Part 2
- Summary
- Study Questions [Go to Page]
- References
- CHAPTER 03 Finding Scientific Evidence for Clinical Improvement [Go to Page]
- The importance of Evidence-Based Practice [Go to Page]
- Sources Beyond Research
- Limitations of EBP [Go to Page]
- Linking evidence to systems of care
- Formulating the Right Questions [Go to Page]
- Questions to Find Evidence for Patient Care [Go to Page]
- The PICO method: Creating foreground questions
- Questions to Find Evidence on Populations and Systems
- Filtered and Unfiltered Evidence, “Right” and “Best” Answers
- Evaluating the Strength of Evidence [Go to Page]
- Unfiltered Information [Go to Page]
- Cohort studies [Go to Page]
- Randomized controlled trials
- Filtered Information [Go to Page]
- Evidence syntheses
- Systematic reviews
- Perspectives of filtered information
- Level of Evidence
- Choosing the Right Resources Based on the Question
- Working with a Reference Librarian [Go to Page]
- Levels of Literature Searches
- Summary
- Study Questions [Go to Page]
- Scenario 1
- Scenario 2
- References
- CHAPTER 04 Identifying a Focus for Improvement [Go to Page]
- Step 1: identify a General Area to improve [Go to Page]
- Approaches to Identifying Improvement Areas
- Step 2: Narrow the Focus of the improvement Work [Go to Page]
- Criteria to Focus Improvement Work
- Step 3: Create a SMART Global Aim Statement to Guide the improvement Work
- Using SMART Criteria to Define a Clear Global Aim Statement
- Summary
- Study Questions [Go to Page]
- Identifying Opportunities for Improvement [Go to Page]
- Scenario 1
- Scenario 2 [Go to Page]
- Identifying and Evaluating the Components of an Aim Statement
- Scenario 1
- Scenario 2
- Scenario 3 [Go to Page]
- References
- CHAPTER 05 Process Literacy, Context, Culture, and Systems in Health Care [Go to Page]
- Process Analysis [Go to Page]
- The Importance of Process Analysis
- Process Analysis Methods [Go to Page]
- Brainstorming
- Flowchart or Process Map
- Deployment Flowcharts
- Workflow Diagrams
- Clinic Visits, Continued
- Context, Culture, and Systems [Go to Page]
- Context
- Culture
- Systems
- Process, Context, and System Analysis Methods [Go to Page]
- Readiness for Change
- Cause-and-Effect Diagrams
- Driver Diagram
- Process, Context, and Systems in implementation Science
- Summary
- Study Questions [Go to Page]
- Cause-and-Effect Diagram
- References
- CHAPTER 06 Measurement Part 1: Data Analysis for Decision-Making in Health Care [Go to Page]
- importance of Data for the improvement of Health Care [Go to Page]
- Historical Foundations for Using Data to Improve Care [Go to Page]
- Florence Nightingale’s polar-area diagram [Go to Page]
- Ernest Codman’s end result system
- Challenges in Applying Data to Improve Care
- Building Measurement Knowledge [Go to Page]
- Fundamental Approaches to Measurement [Go to Page]
- Research
- Accountability
- Improvement
- Navigating the Interfaces of Measurement Approaches
- Understanding Variation in Measurement for Improvement [Go to Page]
- Understanding variation in data is vital for taking action
- Potential consequences of not understanding variation
- The critical role of measurement for improvement
- identifying a Balanced Set of Measures for improvement [Go to Page]
- Identifying Appropriate Measures of Value [Go to Page]
- Process, outcome, and balancing measures
- The value equation [Go to Page]
- Quality
- Step 1: Brainstorming to identify measures
- Step 2: Narrowing the list of possible measures [Go to Page]
- Quality [Go to Page]
- Clinical outcomes and results
- Functional status of patients or the system
- Satisfaction of stakeholders
- Costs
- Social drivers of health
- Step 3: Creating operational definitions
- Step 4: Qualitative or quantitative measures?
- Using Other Data Instruments or Collection Methods
- Summary
- Study Questions
- References
- CHAPTER 07 Measurement Part 2: Using Run Charts and Statistical Process Control Charts to Gain Insight into Systems [Go to Page]
- Quality improvement Measurement: Evaluating Systems over Time
- Common- and Special-Cause variation [Go to Page]
- Implications of Differences in Causes of Variation
- Run Charts and Statistical Process Control Charts: The Basics [Go to Page]
- Analyzing Why a Significant System Change (Special-Cause Variation) Occurs
- Run Charts
- Rules of Detection in Run Charts [Go to Page]
- Determining the reason for special-cause variation
- Statistical Process Control (SPC) Charts
- interpreting Statistical Process Control Charts [Go to Page]
- Rules of Detection in Statistical Process Control Charts
- Acting on Interpretations from the Charts
- Using Statistical Process Control Charts to Predict Future Performance
- Control Limits for Groups of Data
- Using XmR Control Charts
- Summary
- Study Questions [Go to Page]
- References
- CHAPTER 08 Understanding and Making Changes in a System [Go to Page]
- The Complexity of Systems Changes [Go to Page]
- The Model for Improvement: Identifying Specific Changes to Test [Go to Page]
- The two-part final stage of the Model for Improvement
- The evidence-based improvement formula applied to changes in a system
- IMPLEMENTATION SCIENCE
- Managing Changes in a System
- Patterns of Responses to Change/ Innovation [Go to Page]
- Identifying Possible Changes Using Change Concepts [Go to Page]
- PDSA 1
- Using PDSA Cycles to Test and Assess Changes [Go to Page]
- Embedding knowledge gained from the Model for Improvement into a system
- Barriers and Facilitators to Change
- Summary
- Study Questions [Go to Page]
- References
- CHAPTER 09 Spreading Improvements [Go to Page]
- Spread: Overview and Definition
- Step 1: Setting a Foundation for Spread [Go to Page]
- Establishing a Spread Team
- Aligning a Spread Effort with Strategic Goals
- Establishing a Spread Aim
- Step 2: Developing an initial Plan for Spread
- Developing a Communication Plan
- Addressing response to change [Go to Page]
- Using the Social System for Spread [Go to Page]
- Using the department and unit structure
- Removing environmental barriers
- Measurement [Go to Page]
- Collecting the data
- Sharing the data
- Accountability for the data
- Responding to the data
- Step 3: Carrying Out and Refining the Spread Plan [Go to Page]
- Sustaining Improvement
- Recommended Spread Effort Components
- Summary [Go to Page]
- Spread Through Learner and Patient/Family Networks
- References
- CHAPTER 10 Publishing and Presenting Quality Improvement [Go to Page]
- Dissemination of improvement Work [Go to Page]
- Presenting Quality Improvement
- Publishing Quality Improvement
- SQUIRE 2.0
- Notes to Authors
- Title and Abstract [Go to Page]
- Rationale
- Context
- Study of the intervention(s)
- Other resources in the guidelines
- Differentiating Between improvement and Research
- Summary [Go to Page]
- References
- APPENDIX Tools to Help Your Improvement Work
- improvement Project Worksheet [Go to Page]
- The Seven-Step Meeting Process
- Team Roles
- Team Charter
- Readiness for Change
- Collaborator Assessment [Go to Page]
- Collaborators
- Opinion Leaders
- Customers
- Complex Adaptive System [Go to Page]
- Reference
- Timeline
- Communication Plan
- Tools from the institute for Healthcare improvement (iHi)
- Driver Diagram [Go to Page]
- Instructions:
- Tips for Developing a Survey and Collecting Real-Time Data
- Change Concepts Worksheet
- Plan-Do-Study-Act (PDSA) Worksheet
- Team Evaluation [Go to Page]
- Goals, Roles, Processes, and Interpersonal (GRPI) Analysis Tool
- Creating a Storyboard
- Reviewing the Literature: The CRAAP Test
- INDEX [Go to Page]
- A
- B
- C
- D
- E
- F
- G
- H
- I
- J
- L
- M
- N
- O
- P
- Q
- R
- S
- T
- U
- V
- W
- X [Go to Page]