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Pages 2-7

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From page 2...
... encounter substantial barriers in making threshold changes in their performance and even greater barriers in disseminating their successes within or across organizations. At the same time, the morale of health care professionals has been severely strained by efforts to do more with fewer resources even while coping with an avalanche of new technologies and knowledge.
From page 3...
... The micro-system study explored whether such an approach to understanding highly effective systems could be applied to professional organizations, and, in particular, to health care units a special' form of service industry often thought to be unique because inputs (pa~ ~ ~ ~ - .1 - - - — J.~ ~& teentsy are so vanable, outputs ~ll-det~ned, and the need for professional expertise so great. Health care requires a mix of rules-based action and judgment based on individual needs, and this combination seemed to defy simple notions based on manufacturing.
From page 4...
... However, most often these small systems their elements and working dynamics are not recognized by the larger organizations that provide the organizational context for their work, such as in the design of human resource policies and information technologies, or by groups outside health care organizations, such as third party payers devising payment policies and employers seeking accountability for the care of their employees. As a result, payment and incentives may ignore collaborative working relationships and be misdirected at too "low" or too "high" a level.
From page 5...
... That is, in addition to linkages among microsystems, micro-systems may be part of a larger organization (e.g., a cardiac care unit in a hospital, a group practice that has contracts with health plans, an ophthamology practice within a multispecialty clinic) , and they are embedded in and interact with a legal, financial, and regulatory environment that may foster or impede their effectiveness.
From page 6...
... Data gathered in a quantitative study is in the form of numbers evaluated using descriptive and inferential statistics. A quantitative approach to a study on health care micro-systems might involve a variable-oriented analysis that computes the correlation between a variable and a selected outcome.
From page 7...
... A variable-oriented approach to cross-case analysis starts with a framework of several variables or themes that cut across cases. For example, variables that may be relevant to a study of health care micro-systems may be the use of information, the role of information technology, or coordination of patient care.

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