Systems theoryViews an organization as a set of interdependent parts that together form a whole. The interdependent nature of the parts of the organization suggests that anything that affects the functioning of one aspect of the organization will affect the other parts of the organization (Cherry & Jacob, 2011).
A small group of people who work together on a regular basis to provide services to individuals within a discrete subpopulations.As a functioning unit, it has business aims, linked processes, a shared information and technology environment and produces services and care which can be measured as performance outcomes. These systems evolve over time and are (often) embedded in larger systems/organisations. As any living complex adaptive system, the microsystem must: do the work, meet member needs and maintain itself as a functioning clinical unit.
Leadership- Aid the team to reach collective goals through knowledge building, respect, review and reflection. Organisational support- The larger system supports the smaller Microsystems. Staff focus- Hiring the right people, high expectations regarding performance, education, professional growth and networking. Education and training- Ongoing education and competencies for all staff involved in the microsystem. Interdependence- Ability to function independently and collaboratively. Patient focus- Primary concern is to meet patient needs. Community and market focus- The community is a resource for the microsystem and vice versa. Performance results- Focuses on patient outcomes, avoidable costs, streamlining delivery, using data and promoting positive competition. Process improvement- Continuous review and quality improvement of processes. Information and information technology- Transfer of information between all sectors
Clinical microsystems are the front-line units that provide most health care to most people. They are the places where patients, families and care teams meet. Microsystems also include support staff, processes, technology and recurring patterns of information, behavior and results. Central to every clinical microsystem is the patient.The primaryaimof a clinical microsystem is toprovidecare. The outcomeof and responsetothese services is monitored and assessedtofulfill the secondaryaimof the clinical microsystem, toimprovecare.
SYSTEMS ANDMICROSYSTEMSAstrid Grgurich & Jess Morritt
Systems and Microsystems 1. Systems and microsystems: what are they and the theories behind them 2. Microsystems in context of tool application 3. Outcomes and quality care, including a case study
What is a Microsystem A small group of people who work together on a regular basis to provide services to individuals within a discrete subpopulations. Aims, processes, information and technology and outcomes.1. Do the work.2. Meet member needs.3. Maintain itself as a functioning unit. (Foster, Johnson, Nelson & Batalden,2007)
Characteristics of ClinicalMicrosystems (Foster, Johnson, Nelson & Batalden, 2007)
Chain of Effect in Improving HealthCare Quality (Nelson, et al., 2007).
Structure of the Health System 1. Bigger systems (macrosystems) are made of smaller systems 2. These smaller systems (microsystems) produce quality, safety, and cost outcomes at the from line of care 3. Ultimately the outcomes of the macrosystems can be no better than the microsystems of which it is composed (Nelson, et al., 2007).
Patient Experience of theMicrosystem Patients in need of care may find: Clinical staff working together (or against one another) Smooth-running front-line health care units (or units in tangles) Information readily available, flowing easily, and in a timely fashion (or not) Health care units that are often embedded in helpful larger organisations (or cruel bureaucracies) Health care units that are seamlessly linked together (or totally disjointed) High-quality, sensitive, efficient care (or care that is harmful or even lethal, wasteful, and expensive) (Nelson, et al., 2007).
References Cherry, B., & Jacob, S. (2011). Contemporary nursing: Issues, trends and management (5th ed.). St. Louis, MI: Elsevier Mosby. Foster, T., Johnson, J., Nelson, E., & Batalden, P. (2007). Using a Malcolm Baldrige framework to understand high performing clinical microsystems. Quality Safety Health Care, 16, 334-341. Microsystem Academy. (2011). Clinical microsystems. Retrieved from http://clinicalmicrosystem.org/ Nelson, E., Batalden, P., & Godfrey, M. (Eds.). (2007). Quality by design: A clinical systems approach. San Francisco, CA: Jossey- Bass. Nelson, E., Batalden, P., Huber, T., Mohr, J., Godfrey, M., Headrick, L., & Wasson, J. (2009). Microsystems in health care: Part 1. Learning from high-performing front- line clinical units.Journal on quality improvement, 28(9), 472-493.