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Contents ABSTRACT......................................................................................................................... v INTRODUCTION............................................................................................................... 1 BACKGROUND ................................................................................................................. 2 Defining Health Care Micro-Systems 3 Use of Qualitative Methods 5 METHODS.......................................................................................................................... 8 Stage 1: Literature Review, Nomenclature, and Study Design 8 Operational Definition 9 Stage 2: Study Design and Data Collection 9 Instrument and Protocol Development 9 Site Selection 11 Instrument Testing and Interviewer Reliability 11 Data Collection 13 Stage 3: Data Analysis 19 Case-Level Summary Analysis of Health Care Micro-Systems 19 Cross-Case Analysis 20 RESULTS .......................................................................................................................... 21 I. Case-Level Summaries by Topic 21 Level of Performance 21 Patient Experience 23 Information and Information Technology 25 Improvement 26 Leadership and Management: Lessons for Replication 28 II. Cross-Case AnalysisâThemes Related to Effective Micro-System Performance 47 Integration of Information 47 Measurement 47 Interdependence of the Care Team Members 50 xi