Value by Design is a practical guide for real-world improvement in clinical microsystems. Clinical microsystem theory, as implemented by the Institute for Healthcare Improvement and health care organizations nationally and internationally, is the foundation of high-performing front line health care teams who achieve exceptional quality and value. These authors combine theory and principles to create a strategic framework and field-tested tools to assess and improve systems of care. Their approach links patients, families, health care professionals and strategic organizational goals at all levels of the organization: micro, meso and macrosystem levels to achieve the ultimate quality and value a health care system is capable of offering.
At a time when policy makers are increasingly interested in shared decision making, this book tells the story of how to deliver tools created to help patients make better informed decisions. The real-world cases in this book, describe how pioneers from the US and UK introduced tools designed to help patients become well informed about tough decisions. They describe efforts to get the tools integrated into healthcare systems, sometimes with success, but often in the face of seemingly insurmountable obstacles. To better understand the challenges, each case in this book is reviewed through the lens of three different perspectives: Relational Coordination Theory presented by Jody Hoffer Gittell; Normalization Process Theory presented by Glyn Elwyn; and Microsystems presented by Marjorie M Godfrey. In the last chapter, Glyn Elwyn writes a provocative analysis of the steps that might be needed to facilitate large-scale implementation. Elliott Fisher comments in his foreword that “the gap between promise and reality remains deep and wide.” This book helps explain how we rise to meet this challenge.
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