Godfrey MM, Melin CN, Muething SE, Batalden PB, Nelson EC. Clinical microsystems, part 3: Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies. Joint Commission Journal on Quality and Patient Safety. 2008 Oct;34(10):591-603.

This article describes how two hospitals — a large, urban academic medical center and a rural, community hospital — chose a similar microsystem-based approach to improvement, customizing the engagement and the improvement targets on the basis of an understanding of the local context. The authors conclude that their improvement experience suggests tips and actions at all levels of the organization that could be adapted with specific context knowledge by others.

Berwick DM. Escape Fire: Lessons for the Future of Health Care. New York, New York: The Commonwealth Fund; November 2002.

This monograph presents the December 9, 1999, “Escape Fire” keynote address by IHI President and CEO Dr. Donald M. Berwick at IHI’s 11th Annual National Forum on Quality Improvement in Health Care, in which he describes a 1949 wildfire that broke out on a Montana hillside, taking the lives of 13 young men and changing the way firefighting was managed in the United States. Dr. Berwick applies the lessons learned from this catastrophe to the health care system and outlines an ambitious program for reform, what Berwick calls an "escape fire," the term firefighters use for a deliberately burnt patch of land that, in an emergency, can provide refuge from an oncoming blaze.

Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney SE; for the SQUIRE development group. Publication guidelines for quality improvement in health care: Evolution of the SQUIRE project. Quality and Safety in Health Care. 2008 Oct;17(Suppl 1):i3-i9.

In 2005, draft guidelines were published for reporting studies of health care quality improvement interventions. This article contains the full revised version of the guidelines, which the authors refer to as SQUIRE (Standards for QUality Improvement Reporting Excellence). Also see the accompanying Explanation and Elaboration article.

Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP. Evidence for the impact of quality improvement collaboratives: Systematic review. British Medical Journal. 2008 Jun 28;336(7659):1491-1494.

The authors conclude that the evidence underlying quality improvement collaboratives is positive but limited. They suggest that further knowledge to understand the basic components and success factors is needed. The accompanying Lindenauer editorial states that many improvement collaboratives "have improved care and saved many lives at participating hospitals," and he suggests these positive effects might have been missed due to various factors.

Kenney C
New York, New York: PublicAffairs; 2008

Starting in the late 1990s, reports emerged showing that treatment-related deaths were the fifth leading cause of death for Americans, and hundreds of thousands of patients were being harmed by medical procedures. A group of visionary physicians, led by Donald Berwick and Paul Batalden, embarked on applying industrial quality improvement techniques in health care despite resistance from the medical community. This book tells the story of the burgeoning health care quality movement, and of how the medical landscape is being radically transformed — for the better. *For every book ordered using the Amazon.com link below, IHI will donate 10% of the purchase price to Medically Induced Trauma Support Services (MITSS).

Wasson JH, Anders SG, Moore LG, et al. Clinical microsystems, part 2: Learning from micro practices about providing patients the care they want and need. Joint Commission Journal on Quality and Patient Safety. 2008 Aug;34(8):445-452.

Small, independent practices — micro practices — are incorporating attributes of successful microsystems such as patient focus, process improvement, performance patterns, and information technology to provide patients with the care they want and need.

Nelson EC, Godfrey MM, Batalden PB, et al. Clinical microsystems, part 1: The building blocks of health systems. Joint Commission Journal on Quality and Patient Safety. 2008 Jul;34(7):367-378.

The body of knowledge on clinical microsystems can guide and support innovation and peak performance. Patients move into and out of an assortment of clinical microsystems such as a family practitioner's office, an emergency department, and an intensive care unit — their own unique "health system." This patient-centric view of a health system is the foundation of second-generation development for clinical microsystems.

Berwick DM. The science of improvement. Journal of the American Medical Association. 2008 Mar;299(10):1182-1184.

Individuals most involved in day-to-day improvement work in health care fear that if "evidence" is too narrowly defined and the approach to gathering evidence too severely constrained, progress may be the victim. The author discusses the question, "How can accumulating local reports of effectiveness of improvement interventions... be reconciled with contrary findings from formal trials with their own varying imperfections?"

Chalice R
Milwaukee, Wisconsin: ASQ Quality Press; 2007

This book details 46 steps, based on Toyota Lean Production methods, that health care providers can implement to reduce waste, lower cost, and improve quality. Practical examples demonstrate how to directly apply these successful methods to health care.

Berwick DM, Kaplan M. "What's the ethics of that?" A conversation with Thomas O. Pyle. Health Affairs. 2008 Jan/Feb;27(1):143-150.

Thomas O. Pyle served in the top echelons of the Harvard Community Health Plan (HCHP) for nineteen years. In that time, HCHP became the largest health maintenance organization in New England, and its reputation for innovation and entrepreneurship rose to the top ranks of the industry. This interview explores Pyle’s background, his interpretation of HCHP’s evolution and eventual transition to a much different organization, and his recommendations for the future.