2. 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.
3. The microsystem is the place where
๏ Patients, families and health care teams meet.
๏ Care is made
๏ Quality, safety, reliability, efficiency and innovation are
made
๏ Staff morale and patient satisfaction are made
4. 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
5. 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 worldโs best of best service organisations,
such as FedEx
9. Micro โ Meso โ Macro Framework
Six stages can be identified in the development of the
relationship 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+m3โฆ+M1)
5. A group of like macrosystems (M1+ M1+ M1โฆ)
6. A group of unlike macrosystems (M1+ M2+ M3โฆ)
10.
11. It can be used in:
๏ family practitionerโs office,
๏ an emergency department,
๏ an intensive care unit,
๏ a surgical suite,
๏ an inpatient care unit,
๏ a cardiologistโs office,
๏ a cardiac rehabilitation program,
๏ a nutritionistโs office,
๏ home-based nursing care from a visiting nurse
12. 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?
13. Benefits
Improving patient safety (Mohr, Batalden & Barach,
2004)
๏ Safety is a property of the clinical microsystem
๏ An important level at which to focus patient safety
interventions
๏ Systems level that most patients and caregivers meet
๏ Errors occur within the microsystem
14. 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
๏ 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)
15. Benefits
๏ Focus 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)
16. Negatives
๏ Clinical 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 โmade me do it.โ Blaming
the system is in league with a feeling of helplessness
17. How microsystems work and those
included
๏ We have this assortment of clinical microsystems as well as
the patientโs own actions to improve or maintain health
which can be viewed as the patientโs 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.
18. Effective microsystems
1. Strong Leadership
LEADERSHIP STAFF
2. Great Organizational Support
ลธ Leadership ลธ Staff Focus 3. Focus on Staff (Professionals)
ลธ Organizational ลธ Educationand
Training
Support
ลธ Interdependence 4. Education and Training of Staff
of Care Team
Information
and
5. Interdependence of Care Team
Information
PERFORMANCE
Technology
PATIENTS
6. Performance Result Focused
ลธ Performance ลธ Patient Focus 7. Process Improvement Focused
Results ลธ Community and
ลธ Process
Improvement
MarketFocus
8. Patient-Centered (Patient Focus)
9. Community and Market Focus
10. Information & Information
Technology Orientation
19. 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_resourc
es/techniques/microsystems.html
Editor's Notes
http://www.clinicalmicrosystem.org/about/background/Gill, M., & Gray, M. (2006). Using Clinical Microsystems and Mesosystems as enablers for service improvement in mental health services. Retrieved from http://www.lj.se/info_files/infosida31595/micro_mesosystems_mjg_mdg.pdfNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.
Mohr J, Batalden P, Barach P. (2004). Integrating patient safety into the clinical microsystem. Department of Medicine, University of ChicagoRetrived on April 7 from:http://qualitysafety.bmj.com/content/13/suppl_2/ii34.full#ref-4
Inside out โ creating the condition โ outside inReferencesGodfrey, Nelson, & Batalden (2008). . Retrieved from [PDF] Table 3. Micro-Meso-Macro Framework Clinical Microsystem ...clinicalmicrosystem.org/materials/.../m3_matrix.pdfEspinosa, J. A., & Kosnik, L. (2003, Sept). Microsystems in Health Care. Joint Commission on Quality and Safety, 29, 452-459. Retrieved from http://clinicalmicrosystem.org/materials/publications/JQIPart7.pdf
Mohr, J, Batalden P, & Barach P. (2004). Integrating patient safety into the clinical microsystem.Qual saf health care, 13.
NHS Improvement programme. (2008). Further Resources:ย Service Improvement Tools and Technques. Retrieved 9 April 2012. http://www.improvement.nhs.uk/heart/sustainability/further_resources/techniques/microsystems.html
NHS Improvement programme. (2008). Further Resources:ย Service Improvement Tools and Technques. Retrieved 9 April 2012. http://www.improvement.nhs.uk/heart/sustainability/further_resources/techniques/microsystems.html
Gill, M., & Gray, M. (2006). Using Clinical Microsystems and Mesosystems as enablers for service improvement in mental health services. Retrieved from http://www.lj.se/info_files/infosida31595/micro_mesosystems_mjg_mdg.