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.
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
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
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
Micro – Meso – Macro FrameworkSix 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 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?
BenefitsImproving 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
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 Produce better outcomes for patients and populations; Produce better operating performance for the health care organizations that are in business to provide care; (NHS Improvement programme, 2008)
Benefits Focus of improvement or development is based on an understanding of priorities from both patient and staff perspectives. 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)
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 “made me do it.” Blaming the system is in league with a feeling of helplessness
How microsystems work and thoseincluded We 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 microsystems 1. Strong Leadership LEADERSHIP STAFF 2. Great Organizational Support Ÿ Leadership Ÿ Staff Focus 3. Focus on Staff (Professionals) Ÿ Organizational Ÿ Educationand Training Support Ÿ 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 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_resourc es/techniques/microsystems.html