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Microsystem analysis webinar_feb_21_2013[1]
1. Know your Clinical Setting:
Microsystem Analysis
Carol Callaway-Lane, DNP, ANCP-BC
2. Define a clinical microsystem
Identify the role of a clinical microsystem within
the context of a larger healthcare macrosystem
Distinguish methods of evaluating a clinical
microsystem using the 5 P‟s; and
State the importance of evaluating the clinical
setting before proceeding with quality
improvement changes.
4. Providers need to be able to:
◦ Assess the needs of a population of
patients
◦ Give the right care to the right patients at
the right time for the right cost.
◦ Understand the health care system
◦ Improve the health of a population
5. Simple
Model of Improvement model for
Aims complex
What are we trying to accomplish?
issues….
Measures
How will we know if a change is an But what
improvement? happens
Process Analysis before you
What changes can we make that will result define your
in improvement?
specific
Act Plan
aim??
(Stop or Spread) Improvement
PDSA
Cycle
You must
Study Do evaluate
Results Improvement
your clinical
setting.
6. Improvement Idea
Assembly a Team
Evaluate the Clinical Setting
Determine Baseline
Measurement
Model for Improvement
7. Micro-systems are
the building blocks
that come together to form the
macro-organization or the macrosystem
7
8. Market /
Geopolitical
Veteran
system (Fed
Self-care
Govt)
system
VA
Macrosystem
(Facility/VISN)
Individual
care-giver
& Veteran
system
VA
VA Mesosystem
Microsystem
9. The combination of a small team of people
who work together on a regular basis—or as
needed—to provide care and the individuals
who receive that care (who can also be
recognized as members of a discrete
subpopulation of patients.)
Dartmouth Clinical Microsystem
10. A clinical microsystem has clinical and
business aims, linked processes, a shared
information environment and produces
services
Care which can be measured as
performance outcomes. These systems
evolve over time and are (often) embedded
in larger systems organizations.
Dartmouth Clinical Microsystem
11. Core team of health professionals
Defined population of people they care for
Information & information technology
Support staff, equipment, environment
Processes, activities specific to accomplishing
the aim
13. Purpose: What you do
Patients: Who you care for
Personnel: who provides the care
Processes: SOP‟s
Patterns: safety, functional status,
14. What is the primary goal of your clinical area
or „microsystem‟
Mission statement or definition of the area
What is the unique contribution that it makes
within the overall macrosystem?
15. Who is receiving the care?
What are the characteristics of the
patients when they enter your
microsystem?
◦ Who are they?
◦ How old are they?
◦ What are the top diagnoses?
◦ What is their state of health?
◦ How did they enter your microsystem?
◦ What are their “health care needs”
16. Who are the people who are a part of your
microsystem?
What is their skill level?
What do they think about their work?
What are the characteristics of their work time?
17. What types of processes does the
environment do?
Think of routines or standard operating
procedures they you do.
20. Patterns measure the performance of the
microsystem. Patterns of:
◦ leadership, cultural, traditional workflow
They gauge the value of care.
◦ What types of safety mechanisms are in place
◦ Are there meetings to discuss outcomes of care on
a regular basis?
◦ Are there faculty/staff meetings to discuss the
successes/struggles of the environment?
21. 1. Providers + beneficiaries
2. People + Information Technology
3. People, Work in a setting
4. Purpose
22. You cannot effectively change a system that
you do not fully understand
Avoid unintended consequences
Engagement of members of the microsystem
or environment
Evaluating your microsystem is the first step
to quality improvement
Editor's Notes
At the end of this webinar, each participant will be able to:
