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