Mayo Clinic Department of Radiology Quality Improvement Reading List

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LA and Thomas EJ. Understanding diagnostic errors in medicine: a lesson from aviation. Qual Saf Health Care 2006; 15:159-164. Spear SJ. Fixing HealthCare from the Inside, Today. Harvard Business Review 2005: 78-91 Wennberg JE. Variation in use of Medicine Services Among Regions and Selected Academic Medical Centers: Is More Better? Commonwealth Fund 2005 Jan 24, www.cmwf.org , 1-43. Williams SC, Schmaltz SP, Morton DJ, Koss RG, Loeb JM. Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002-2004. N Engl J Med 2005 Jul 21; 353:255-64. Zhan C, Miller MR. Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization. 2003;290:1868-1874. Adverse Events - Monitoring and Prevention Bates DW and Gawande AA. Improving Safety with Information Technology. N Engl J Med 2003; 348;2526-34. Reason J. Human error: models and management. BMJ 2000;320:768-70. Rozich JD, Resar RK. Medication Safety: One Organization 9s Approach to the Challenge. JCOM Oct 2001 Vol 8 No 10. Volpp KGM, Grande D. Residents 9 Suggestions for Reducing Errors in Teaching Hospitals. N Engl J Med 348; 9:851-5. Mayo Clinic Department of Radiology Quality Improvement Reading List srs Page 3 7/30/2008 Weingart SN, Iezzoni LI. Looking for Medical Injuries Where the Light Is Bright. JAMA Oct 8, 2003 Col 290 No 14. Weingart SN, Ship AN, Aronson MD. Confidential Clinician-reported Surveillance of Adverse Events Among Medical Inpatients . J Gen Intern Med 2000;15: 470-7. Weingart SN, Wilson R, Gibberd RW, Harrison B. Epidemiology of medical error. BMJ 2000;320 :774-7. When Things go Wrong: Responding to Adverse Events. A Consensus Statement of the Harvard Hospital. March 2006. www.macoalition.org Woolf S. Patient Safety Is Not Enough: Targeting Quality Improvements To Optimize the Health of the Population. Ann Intern Med 2004 ;140:33-6. Culture Barach P and Berwick DM. Patient Safety and the Reliability of Health Care Systems (Editorial). Ann Intern Med 2003; 138:997-998. Baron RJ. Personal Metrics for Practice 3 How 9m I Doing? N Engl J Med 353;19 Nov 10, 2005. Davidoff F. Shame: the elephant in the room, managing shame is important for improving health care. Editorial, BMJ Vol 2 May 2002 (originally appeared in BMJ March 16, 2002 issue (324:623-4). Hallinan JT. Anesthesiologists Now Offer Model of How to Improve Safety, Lower Premiums Surgeons Are Following Suit. Wall Street Journal June 21, 2005, p A1. Holmboe ES, Cassel CK. The Role of Physicians and Certification Boards to Improve Quality. Am J Med Qual 2007;22:18-25. Reinertsen JL. Zen and the Art of Physician Autonomy Maintenance. Ann Intern Med 2003;138:992-5. University Healthsystem Consortium. Building a Culture of Quality and Safety: Organizational Characteristics Associated with Superior Performance in Quality and Safety. September 2005 Weick KE, Roberts KH. Collective Mind in Organizations: Heedful Interrelating on Flight Decks. Administrative Science Quarterly 38 1993;357-81. Mayo Clinic Department of Radiology Quality Improvement Reading List srs Page 4 7/30/2008 External Reporting LeapFrog - http://www.leapfroggroup.org/ National Quality Forum. Safe Practices for Better Healthcare: Summary. http://www.ahrq.gov/qual/nqfpract.htm The Joint Commission - http://www.jointcommission.org/ Improvement Methods deKoning H, Verver JPS, van den Heuvel J, Bisgaard S, Does RJMM. Lean Six Sigma in Healthcare. National Association of Healthcare Quality 2006;March/April Nolan T, Resar R, Haraden C, Griffin FA. Improving the Reliability of Healthcare. Institute for Healthcare Improvement, 2004, www.ihi.org , retrieved January 17, 2007 Singh H, Petersen LA, Thomas EJ. Understanding Diagnostic Errors in Medicine: A Lesson from Aviation. Quality & Safety in Healthcare ; Vol 15, 159-164 Smith B. Lean and Six Sigma 3 A One-Two Punch. Quality Progress 2003; Vol 37-41 Spear S, Bowen HK. Decoding the DNA of the Toyota Production System. Harvard Business Review 1999; Sept-Oct;97-106. Speroff T, O 9Connor GT. Study Designs for PDSA Quality Improvement Research. Qual Mgmt in Health Care 2004; 13:17-32. The Basics of FMEA, Productivity Inc. Copyright 1996 Resource Engineering Inc.: Goodman SL Design for Manufacturability at Midwest Industries, Harvard Business School February 2, 1996. Womack JP, Byrne AP, Fuime OJ, Kaplan GS, Toussaint J. Going Lean in Healthcare. Institute for Healthcare Improvement, 2005, www.ihi.org , retrieved January 17, 2007 Wheelwright SC and Clark KB. Revolutionizing Product Development; Quantum Leaps in Speed, Efficiency and Quality. The Free Press; Potential Failure Modes and Effects Analysis. Automotive Industry Action Group 1993. Pay for Performance Thrall, JH. The Emerging Role of Pay-for-Performance Contracting for Health Care Services. Radiology 2004;233:637-640. Mayo Clinic Department of Radiology Quality Improvement Reading List srs Page 5 7/30/2008 Radiology Aakre KT, Johnson CD. Plain-Radiographic Image Labeling: A Process to Improve Clinical Outcomes. J Am Coll Radiol 2006;3:949-953. Alderson PO. Noninterpretive Skills for Radiology Residents: Customer Service and Satisfaction in Radiology. AJR 2000;175:319-323. Applegate KE. Continue Quality Improvement for Radiologists. Acad Radiol 2004;11:155-161. Blane CE, Dunnick R, Cotton LA, Cascade PN. Continuous Quality Improvement Process to Track Lost Radiographs and Reduce Losses. Can Assoc Radiol J 2001;52(6)373-8. Choksi VR, Marn C, Piotrowski MM, Bell Y, Carlos R. Illustrating the Root-Cause-Analysis Process: Creation of a Safety Net with a Semi-automated Process for the Notification of Critical Findings in Diagnostic Imaging. J Am Coll Radiol 2005;2:768-776. FitzGerald R. Radiological Error: Analysis, Standard Setting, Targeted Instruction, and Teamwork. Eur Radiol 2005;15:1760-1767. Gutmark R, Halsted MJ, Perry L, Gold G. Use of Computer Databases to Reduce Radiograph Reading Errors. J Am Coll Radiol 2007;4:65-68. Ondategui-Parra S, Erturk SM, Ros PR. Survey of the Use of Quality Indicators in Academic Radiology Departments. AJR 2006;187(5):W451-5. Pescarini L, Inches I. Systematic Approach to Human Error in Radiology. Radiol Med 2006;111:252-267. Preston CA, Marr JJ, Amaraneni KK, Suthar BS. Reduction of cCallbacks d to the ED Due to Discrepancies in Plain Radiograph Interpretation. Am J Emerg Med 1998;16(2):160-162. Robert L, Cohen MD, Jennings GS. A New Method of Evaluating the Quality of Radiology Reports. Acad Radiol 2006;13:241-248. Swensen SJ, Johnson CD. Radiologic Quality and Safety: Mapping Value Into Radiology. J Am Coll Radiol 2005;2:992-1000. Miscellaneous Botwinick L, Bisognano M, Haraden C. Leadership Guide to Patient Safety. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2006. (Available on www.IHI.org ). Freiesleben J. What Are Quality Reputations Worth. Quality Progress 2006; 35-40. Mayo Clinic Department of Radiology Quality Improvement Reading List srs Page 6 7/30/2008 Wang MC, Hyun JK, Harrison MI, Shortell SM, Fraser I. Resdesigning Health Systems for Quality: Lessons for Emergency Practices. Joint Commission Journal on Quality and Patient Safety 2006; 32(11):599-611. Books for Further Reading (In descending order of importance) Kohn LT, Corrigan JM, Donaldson MS. To Err is Human , Building a Safer Health System. National Academy Press (Wash, DC); 2000. Lawton RL. Creating a Customer-Centered Culture, Leadership in Quality, Innovation, and Speed. ASQ Quality Press (Milwaukee, WI); 1993. Weick KE, Sutcliffe KM. Managing the Unexpected ., Assuring High Performance in an Age of Complexity. Jossey-Bass (CA); 2001. 200 p. Ransom SB, Joshi MS, Nash DB. The Healthcare Quality Book Health Administration Press (IL) AUPHA Press (Wash, DC); 2005. 425 p. Langley GL, Nolan KM, Nolan TW et al. The Improvement Guide , A Practical Approach to Enhancing Organizational Performance. Jossey-Bass (CA); 1996. 370p. Liker JK. The Toyota Way , 14 Management Principles from the World 9s Greatest Manufacturer. McGraw-Hill (NY); 2004. 330 p. Womack JP, Jones DT. Lean Thinking , Banish Waste and Create Wealth in Your Corporation. Free Press (NY); 2003. 396 p. Schein EH. Organizational Culture and Leadership . 3 rd ed. Jossey-Bass (CA); 2004. 437 p. Juran JM. Architect of Quality . McGraw-Hill (NY); 2004. 379 p. Kaplan RS, Norton DP. Translating Strategy into action, The Balanced Scoreboard . Harvard Business School Press (MA); 1996. 322 p. Berwick DM. Escape Fire , Designs for the Future of Health Care. Jossey-Bass (CA); 2004. 315 p. Wiegmann DA, Shappell SA. A Human Error Approach to Aviation Accident Analysis. Ashgate Publishing Limited (NH); 2004. 165 p. Bossidy L, Charan R. Execution , The Discipline of Getting Things Done. Crown Business (NY); 2002. 278 p. Mayo Clinic Department of Radiology Quality Improvement Reading List srs Page 7 7/30/2008 Snee RD, Hoerl RW. Leading Six Sigma , A Step-by-Step Guide Based on Experience with GE and Other Six Sigma Companies. Financial Times Prentice Hill (NJ); 2003. 279 p. George ML. Lean Six Sigma For Service , How to Use Lean Speed & Six Sigma Quality to Improve Services and Transactions. McGraw-Hill (NY); 2003. 386 p. Reason J Managing the Risks of Organizational Accidents . Ashgate (Burlington VT) 1997; 252 p. Zak H. Doing More with Less: Lean Thinking and Patient Safety in Health Care. ISBN: 0866889515 Caldwell C, Brexler J, Gillem T. Lean Six Sigma for Healthcare: A Senior Leader Guide to Improving Cost and Throughput. IBSN: 0873896475 Keyte B, Locher D. The Complete Lean Enterprice: Value Stream Mapping for Administrative and Office Processes . Chalice R. Stop Rising Healthcare Costs Using Toyota Lean Production Methods: 38 Steps for Improvement. ISBN: 0873896572 Hadfield D, Homes S. The Lean Healthcare Pocket Guide. ISBN: 0977072029 Wheeler D. Understanding Variation . ISBN: 0945320531 Reason J. Human Error . ISBN: 0521314194 Norman D. Design of Everyday Things . ISBN: 0465067107

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