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Improving the simple, complicated and complex realities of community-acquired pneumonia
  1. S K Liu1,
  2. K Homa2,
  3. J R Butterly3,
  4. K B Kirkland3,
  5. P B Batalden4
  1. 1
    Departments of Medicine and Community and Family Medicine, Leadership Preventive Medicine Residency, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  2. 2
    Leadership Preventive Medicine Residency, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  3. 3
    Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  4. 4
    Center for Leadership and Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, Leadership Preventive Medicine Residency, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  1. Dr S K Liu, Departments of Medicine and Community and Family Medicine, Leadership Preventive Medicine Residency, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; Stephen.K.Liu{at}hitchcock.org

Abstract

This paper first describes efforts to improve the care for patients hospitalised with community-acquired pneumonia and the associated changes in quality measures at a rural academic medical centre. The results of the improvement interventions and the associated clinical realities, expected outcomes, measures, improvement interventions and improvement aims are then re-examined using the Glouberman and Zimmerman typology of healthcare problems—simple, complicated and complex. The typology is then used to explore the future design and assessment of improvement interventions, which may allow better matching with the types of problem healthcare providers and organisations are confronted with. Matching improvement interventions with problem category has the possibility of improving the success of improvement efforts and the reliability of care while at the same time preserving needed provider autonomy and judgement to adapt care for more complex problems.

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Footnotes

  • Competing interests: None.

  • Funding: This work was supported through the Leadership Preventive Medicine Residency Program and the Quality Research Grant Program at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

  • See Editorial, p 82

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