Microsystems Phomolo MadomeTrang Nguyen Thi Thuy Calle Lindén Emily 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.
Background• Conceptual 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
BenefitsImproving patient safety (Mohr, Batalden & Barach, 2004) – safety is a property of the clinical micro system – an important level at which to focus patient safety interventions – systems level that most patients and caregivers meet – Errors occur within the micro system
Benefits• Entire 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 – (NHS Improvement programme, 2008)
Benefits• Focus of improvement or development is based on an understanding of priorities from both patient and staff perspectives.• Microsystem approach fits well with any previous or ongoing improvement work – (NHS Improvement programme, 2008)
The microsystem is the place where• Patients and families and health care teams meet.• Care is made• Quality, safety, reliability, efficiency and innovation are made• Staff morale and patient satisfaction are made
Clinical system• Small group of doctors, nurses, other clinicians• Some administrative support• Some information, information technology• A small population of patients• Interdependent for a common aim, purpose
The “Onion” Perspective on Levels of Quality Improvement! Community, market, social Self-care policy system System Marco organization system MicrosystemIndividual care- giver & patient System
Micro-Meso-Macro FrameworkSix stages can be identified in the development of therelationship between macrosystems and microsystems:1. A self-aware microsystem (m12. 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…)
The five P• Purpose - 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?
Effective microsystems 1. Strong Leadership 2. Great Organizational Support LEADERSHIP STAFF 3. Focus on Staff (Professionals) Ÿ Leadership Ÿ Staff Focus Ÿ Organizational Support Ÿ Educationand Training 4. Education and Training of Staff Ÿ Interdependence of Care Team 5. Interdependence of Care Team Information and Information Technology 6. Performance Result FocusedPERFORMANCE PATIENTS Ÿ Performance Ÿ Patient Focus 7. Process Improvement Focused Results Ÿ Community and Ÿ Process Improvement MarketFocus 8. Patient-Centered (Patient Focus) 9. Community and Market Focus 10. Information & Information Technology Orientation
References• Espinosa, 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_reso urces/techniques/microsystems.html