1 Introduction

摘要

Managers of health care organizations are responsible for achieving the "triple aim", which is simultaneous excellence on patient experience, health, and cost (Berwick et al., 2008). Reaching the triple aim requires that organizations improve their patients' experience, improve clinical outcomes for individual patients as well as for a population of patients, and reduce the per capita costs of health care. Rising cost pressures coupled with increased public reporting of clinical outcomes and patient experiences serve to increase competitive pressures on health care organizations (Chou et al., 2014, Moody, 2014, O'Neill, 2015). Therefore, managers must learn how to improve performance across one or more of the three goals of the triple aim. Performance improvement is one approach that organizations can use to learn how processes can be altered to yield higher quality care, better patient experience, and lower costs. We define performance improvement as a structured approach that uses repeated cycles of hypothesis testing to discover how processes can be modified so that they produce output that meets the performance target. In this monograph, we are particularly interested in transformational performance improvement- a change effort that crosses organizational boundaries with the goal of new method. Despite debate about the applicability of the concepts of swift, even flow to health care (Arndt and Bigelow, 1995), many studies have demonstrated the ability of the principles to improve quality of care and efficiency (Douglas and Fredendall, 2004, Furman and Caplan, 2007, Jimmerson et al., 2005, Shortell et al, 1995). Leadership support and physician involvement are two components of successful implementations in hospital settings (Carman et al., 1996, Douglas and Fredendall, 2004, Harrison et al, 2016).