Microsystem3

MicrosystemsPhomolo Madome

Trang Nguyen Thi ThuyCalle LindénEmily Moore

Definition

A clinical microsystem is a group of clinicians and staff working together with a shared clinical purpose to provide care for a population of patients (Mohr, Batalden & Barach, 2004)

It has clinical and business aims, linked processes, shared information environment and produces performance outcomes.

It must do the work, meet staff needs, and maintain itself as a clinical unit.

The microsystem is the place where

Patients, families and health care teams meet.

Care is madeQuality, safety, reliability, efficiency and

innovation are madeStaff morale and patient satisfaction are

made

Clinical systemSmall group of doctors, nurses, other

clinicians Some administrative support Some information, information technology A small population of patients Interdependent for a common aim, purpose

BackgroundConceptual theory of the clinical microsystem

is based on ideas developed by Deming, Senge and Wheatley

Idea for the clinical microsystem stems from the work of Quinn

Analyzed world’s best of best service organisations, such as FedEx

Bronfenbrenner’s Ecological Systems Theory

Framework

Source: NHS Improvement programme. (2008)

Micro – Meso – Macro Framework

Six stages can be identified in the development of therelationship between macrosystems and microsystems:1. A self-aware microsystem (m1)2. A group of like microsystems (m1+ m1+ m1)3. A group of unlike microsystems (m1+m2+m3) 4. A group of microsystems in relationship with a

macrosystem (m1+m2+m3…+M1)5. A group of like macrosystems (M1+ M1+ M1…)6. A group of unlike macrosystems (M1+ M2+ M3…)

It can be used in:family practitioner’s office, an emergency department,an intensive care unit,a surgical suite,an inpatient care unit,a cardiologist’s office,a cardiac rehabilitation program,a nutritionist’s office,home-based nursing care from a visiting

nurse

The five PPurpose - Does the whole team have a clear,

unambiguous understanding of the core function of the microsystem?

Patients - What does the microsystem really know about its patients?

People - What is the microsystem like from the point of view of the staff that work within it?

Processes - How does the microsystem get things done?

Patterns - What data is available to help run the microsystem on a day-to-day basis?

Benefits Improving patient safety (Mohr, Batalden &

Barach, 2004) Safety is a property of the clinical microsystemAn important level at which to focus patient

safety interventionsSystems level that most patients and

caregivers meetErrors occur within the microsystem

BenefitsEntire staff team (both clinical and non-clinical) are

included in the analysis, planning and execution of improvement work.

Microsystem concept provides an effective way of connecting front-line teams to wider organisational priorities

To produce better outcomes for patients and populations; To produce better operating performance for the health

care organizations that are in business to provide care; to attract, develop, and retain caring and competent

health care professionals who are engaged in their work.

(NHS Improvement programme, 2008)

BenefitsFocus of improvement or development is

based on an understanding of priorities from both patient and staff perspectives.

To attract, develop, and retain caring and competent health care professionals who are engaged in their work.

Microsystem approach fits well with any previous or ongoing improvement work(NHS Improvement programme, 2008)

NegativesClinical microsystems are by nature complex,

dynamic, and adaptive systems. Some people have difficulty grasping systems thinking and others, having gotten the idea, personal responsibility, proclaiming that the system “made me do it.” Blaming the system is in league with a feeling of helplessness

How microsystems work and those includedWe have this assortment of clinical microsystems as

well as the patient’s own actions to improve or maintain health which can be viewed as the patient’s unique health system.

This is the foundation of second-generation development for clinical microsystems. The patient needs these different and distinct, yet related,small systems to fit smoothly together as if they were a single health system designed just for the specific patient and tailored to his or her special needs.

E.g. Acute care management, chronic care management, preventative care management.

Effective microsystemsLEADERSHIP STAFF

PERFORMANCE PATIENTS

Ÿ LeadershipŸ Organizational

Support

Ÿ Staff FocusŸ Education and

TrainingŸ Interdependence

of Care Team

Ÿ Patient FocusŸ Community and

Market Focus

Ÿ PerformanceResults

Ÿ ProcessImprovement

Informationand

InformationTechnology

1. Strong Leadership

2. Great Organizational Support

3. Focus on Staff (Professionals)

4. Education and Training of Staff

5. Interdependence of Care Team

6. Performance Result Focused

7. Process Improvement Focused

8. Patient-Centered (Patient Focus)

9. Community and Market Focus

10. Information & Information Technology Orientation

ReferencesEspinosa, J. & Kosnik, L. (2003). Microsystems in Health Care:

Part 7. The Microsystem as a Platform for Merging Strategic Planning and Operations. Joint Commission on Quality and Safety, 29, 452-459.

Mohr, J, Batalden P, & Barach P. (2004). Integrating patient safety into the clinical microsystem. Qual saf health care, 13.

Godfrey, Nelson, & Batalden (2004). Improving Health Care by Improving Your Microsystem: Trustees of Dartmouth College

Gill, M., & Gray, M. (2006). Using Clinical Microsystems and Mesosystems as enablers for service improvement in mental health services. Humber Mental Health Teaching NHS Trust.

NHS Improvement programme. (2008). Further Resources: Service Improvement Tools and Technques. Retrieved 9 April 2012. http://www.improvement.nhs.uk/heart/sustainability/further_resources/techniques/microsystems.html