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Patients and the public have increased expectations concerning the quality, safety, and costs of health care delivery systems. Whether or not to redesign our complex delivery systems is no longer in question. To succeed in improving care and outcomes clinically and financially for our stakeholders, we must design and evaluate tests of change. The change required a fundamental shift in our traditional thinking about healthcare delivery systems. The microsystem I am going to focus on is the operating room team, composed of a cardiothoracic surgeon, physician assistant, anesthesiologist, and scrub nurse. We met monthly and were supported by a quality improvement expert and cardiovascular epidemiologist. During phase 1 we gathered baseline data concerning mechanisms producing neurologic injury. Phase 2, as a multidisciplinary team we met monthly to discuss slight changes……….. Continue