Quality by Design reflects the research and applied training conducted at Dartmouth Medical School and The Dartmouth Institute Microsystem Academy under the leadership of health care improvement gurus Gene Nelson, Paul Batalden, and Marjorie Godfrey. It’s an ideal text for teaching the fundamentals of quality improvement in health care, providing a clear linkage of theory to practice. The second edition advances the clinical microsystem theory by addressing the organizational levels of macrosystems (large entities like hospitals and health care organizations) and mesosystems (intermediate levels of a health care organization, such as information systems, service line programs and centers, and clinical departments, which serve as a link between separate microsystems and support the microsystem by acting as a sort of mediator with the larger macrosytem) in more depth. Field-tested teaching techniques and tools for faculty, interprofessional improvement teams, and leaders of health care systems are presented. New and updated illustrative case studies bring the clinical microsystems approach to life.

Marjorie M. Godfrey, PhD, MS, BSN, FAAN, Co-Director and Founder, Dartmouth Institute Microsystem Academy, and Instructor, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College. 

Tina C. Foster MD, MPH, MSc, Associate Professor of Obstetrics and Gynecology and Community and Family Medicine, Dartmouth-Hitchcock Medical Center. 

Julie K. Johnson, MSPH, PhD, Professor, Department of Surgery and Center for Healthcare Studies, Northwestern University. 

Eugene C. Nelson, DSc, MPH, Director of Population Health and Measurement, Dartmouth-Hitchcock Medical Center, and Professor of Community and Family Medicine, Dartmouth Medical School and The Dartmouth Institute for Health Policy and Clinical Practice. 

Paul Batalden, MD, Professor Emeritus, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College. 

Foreward 
Dedication 
Preface 
Acknowledgements
The Editors
The Contributors 
Introduction 

Chapter 1: Clinical Microsystem- Success Characteristics of High-Performing Microsystems 

Chapter 2: Developing High-Performing Microsystems

Chapter 3: Leading Microsystems, Mesosystems and Macrosystems of Healthcare Service

Chapter 4: Developing Professionals and Improving Work Life 

Chapter 5: Transforming a primary care clinic to an NCQA-certified patient-centered medical home 

Chapter 6: Partnership within the Clinical Microsystems Framework: Coproducing Good Outcomes with Patients and Families 

Chapter 7: Improving Patient Safety- Why is it so Hard to Improve the Care of Patients? 

Chapter 8: Creating an Actionable Healthcare Information Environment to Inform Intelligent Action

Chapter 9: Interprofessional Education and the Clinical Microsystem 

Chapter 10: Leading from the Middle: Microsystem, Mesosystems, and Macrosystems 

Afterword 

Part Two: Activating the Organization and the Dartmouth Microsystem Improvement Curriculum

Part Three: Mesosystem Workbook 

Glossary 
Index