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“Thinking Upstream” to Evaluate and to Improve the Daily Work of the Newborn Intensive Care Unit

Journal of Perinatology volume 21, pages 307–311 (2001)Cite this article

Abstract

One may divide patient care problem-solving approaches into two categories: (1) “Ready, aim, fire” and (2) “Ready, fire, aim.” The present paper invites the reader to think about these distinctions and to identify which of these categories might apply to the reader's daily work experience. Espousing the first of these categories, and anchored in the notions of systems thinking, this paper offers the reader a framework to better understand and implement the daily work of the newborn intensive care unit. This knowledge and competence may be achieved by “thinking upstream,” connecting “downstream” outcomes with “upstream” work process steps. The central elements that govern and inform the process of “thinking upstream” are articulated here in actionable terms.

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Acknowledgements

The central ideas of this paper result from the privilege of a sabbatical year's interaction with the faculty at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire.

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Authors and Affiliations

  1. Pediatrics, Albany Medical College, Albany, NY

    Joseph Schulman MD, MS

  2. Outcomes Research, The Children's Hospital at Albany Medical Center, Albany, NY

    Joseph Schulman MD, MS

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  1. Joseph Schulman MD, MS
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Schulman, J. “Thinking Upstream” to Evaluate and to Improve the Daily Work of the Newborn Intensive Care Unit. J Perinatol 21, 307–311 (2001). https://doi.org/10.1038/sj.jp.7200528

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