1. Phomolo Madome
Trang Nguyen Thi Thuy
Calle Lindén
Emily Moore

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 world’s best of best service
organisations, such as FedEx

6.  Bronfenbrenner’s Ecological Systems Theory

8. Framework
Source: NHS Improvement programme. (2008)

9. Micro – Meso – 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+m3…+M1)
5. A group of like macrosystems (M1+ M1+ M1…)
6. A group of unlike macrosystems (M1+ M2+ M3…)

11. 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

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
 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)

15. 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)

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 “made me
do it.” 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 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.

18. 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

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