SYSTEMS AND MICROSYSTEMS

Astrid 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

Systems Theory

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 Clinical Microsystems

(Foster, Johnson, Nelson & Batalden, 2007)

Chain of Effect in Improving Health Care 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).

Clinical Microsystem

(Microsystem Academy, 2011).

Patient Experience of the Microsystem

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.