This document defines microsystems as small clinical units composed of healthcare professionals and staff who work together to care for a specific patient population. Microsystems have distinct clinical and operational processes, a shared information environment, and aim to improve both patient care and staff experience. The benefits of the microsystem approach include enhanced patient safety, involvement of all staff in improvement efforts, and alignment of frontline work with organizational goals. Key aspects of effective microsystems are strong leadership, interdisciplinary teamwork, staff education, performance measurement, and process improvement focused on patient-centered care.

1. Microsystems
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. 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

5. Benefits
Improving patient safety (Mohr, Batalden &
Barach, 2004)
– safety is a property of the clinical micro system
– an important level at which to focus patient safety
interventions
– systems level that most patients and caregivers
meet
– Errors occur within the micro system

6. 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
– (NHS Improvement programme, 2008)

7. Benefits
• Focus of improvement or development is
based on an understanding of priorities from
both patient and staff perspectives.
• Microsystem approach fits well with any
previous or ongoing improvement work
– (NHS Improvement programme, 2008)

8. The microsystem is the place where
• Patients and families and health care teams
meet.
• Care is made
• Quality, safety, reliability, efficiency and
innovation are made
• Staff morale and patient satisfaction are made

9. 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

10. The “Onion” Perspective on Levels
of Quality Improvement!
Community,
market, social
Self-care
policy system
System
Marco
organization
system
Microsystem
Individual care-
giver & patient
System

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

12. 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…)

13. 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?

14. Effective microsystems
1. Strong Leadership
2. Great Organizational Support
LEADERSHIP STAFF 3. Focus on Staff (Professionals)
Ÿ Leadership Ÿ Staff Focus
Ÿ Organizational
Support
Ÿ Educationand
Training
4. Education and Training of Staff
Ÿ Interdependence
of Care Team 5. Interdependence of Care Team
Information
and
Information
Technology
6. Performance Result Focused
PERFORMANCE PATIENTS
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

15. 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_reso
urces/techniques/microsystems.html