5. How Microsystems are Used in Healthcare
1. Set expectations for all staff and leaders that they have two jobs—to do
their work and to improve their work.
2. Provide all staff and leaders with the basic knowledge and skills that
form the foundation of modern improvement and safety science and
develop internal improvement expertise of supervisors and middle and
senior leaders as part of their leadership development path.
3. Provide all staff the opportunity, time, and space to put their
improvement knowledge, skill, and will to work by encouraging efforts to
improve and innovate as part of daily work.
4. Back up the expectations and the encouragement (to do both jobs) with
recognition, rewards, and an active information environment.
5. Create supporting infrastructural conditions for engagement in
improvement and innovation by aligning them with the organization’s
mission, vision, strategy and operating plans.
6. Clinical Errors
Medical errors may
result more frequently
from the organisation of
healthcare delivery
For example, a study
discovered that failures
at the system level were
the real culprits in over
75% of adverse drug
events
7. Is the microsystem theory applicable to PPE
compliance?
In my opinion… yes!
8. Using the Microsystem Theory
Begin with the
intention to excel.
Involve all the players.
Focus on values that
matter.
Keep both discipline
and rhythm.
Use measurement and
feedback.
Create a learning
system.
9. PPE Compliance
Begin with the intention
to excel.
Involve all the players.
Focus on values that
matter.
Keep both discipline and
rhythm.
Use measurement and
feedback.
Create a learning system.
Notes de l'éditeur
1. Bigger systems (macrosystems) are made of smaller systems2. These smaller systems (microsystems) produce quality, safety, and cost outcomes t the front line of care3. Ultimately the outcomes of the macrosystem can be no better than the microsystems of which it is composedInbetween the macro and microsystemsNelson, C., Godfrey, M., Batalden, P., Berry, S., & Bothe, A. (2008). Clinical Microsystems, Part 1. The Building Blocks of Health Systems. Retrieved January 3, 2012, from http://www.clinicalmicrosystem.org/assets/materials/publications/jc_quality_safety_01.pdf
If the performance of each individual microsystem is optimised, the microsystems within macrosystems can facilitate systematic transformation at all levelsThe system is well served to maintain feed-forward and feed-back loops so new information can flow into future macrosystm planning, which can be deployed at the microsystem level
In this model for feed-forward and feed-back loops in the work of strategic planning and the work of the microsystem, feed-back loops represent the movement of information in multiple directions between the microsystems and macrosystems, thereby allowing for continuous assessment and reassessment.Kosnik, L., & Espinosa, J. (2003). Microsystems in Health Care: Part 7. The Microsystem as a Platform for Merging Strategic Planning and Operations. Retrieved January 3, 2012, from http://clinicalmicrosystem.org/assets/materials/publications/JQIPart7.pdf
One outline of how microsystems work is set out.1. Set expectations for all staff and leaders that they have two jobs—to do their work and to improve their work.2. Provide all staff and leaders with the basic knowledge and skills that form the foundation of modern improvement and safety science and develop internal improvement expertise of supervisors and middle and senior leaders as part of their leadership development path.3. Provide all staff the opportunity, time, and space to put their improvement knowledge, skill, and will to work by encouraging efforts to improve and innovate as part of daily work.4. Back up the expectations and the encouragement (to do both jobs) with recognition, rewards, and an active information environment.5. Create supporting infrastructural conditions for engagement in improvement and innovation by aligning them with the organization’s mission, vision, strategy and operating plans.Nelson, C., Godfrey, M., Batalden, P., Berry, S., & Bothe, A. (2008). Clinical Microsystems, Part 1. The Building Blocks of Health Systems. Retrieved January 3, 2012, from http://www.clinicalmicrosystem.org/assets/materials/publications/jc_quality_safety_01.pdf
Although errors in medication, surgery, and diagnosis are the easiest to detect, medical errors may result more frequently from the organisation of healthcare delivery.For example, a study discovered that failures at the system level were the real culprits in over 75% of adverse drug events.So we can say, that having a solid foundation of safety work ethic at the microsystem level, will mke the whole macrosystem safer.Mohr, J., & Batalden, P. (2002). Improving safety on the front lines: The role of clinical microsystems. Quality & Safety in Health Care, 11(1), 45-50. Retrieved January 3, 2012, from ProQuest database.
Out of a report titled “Developing Small Clinical Units to Attain Peak Performance”, which I think forms a good overview of how to make changes at the microsystem level. and I will then relate to the use of personal protective equipment compliance.Begin with the intention to excel. The improvement process is initiated and sustained with the intention to achieve best possible results. This aim is motivated to do what is best for the patients and families who have the potential to benefit from care.Involve all the players. The leaders who are successful will find ways, over time, to involve all the microsystem players—interdisciplinary staff and patients and families—in the action of analyzing and improving processes and outcomes.Focus on values that matter. The activity that will sustain a virtuous cycle of improvement in performance will connect to core values that matter to patients, families, and staff.Keep both discipline and rhythm. Improvement work can be sustained over time and become part of the clinical microsystem’s culture by initiating new habits and new patterns that have an internal discipline and reliable rhythm. Discipline relates to things such as use of scientific method and open, respectful inquiry into authentic causes and full effects. Rhythm relates to devoting time to improving patient care even as large amounts of time are spent on providing patient care.Use measurement and feedback. The discipline and the rhythm—the information essential for fostering learning systems—are both aided and abetted by using measurement and feedback to assess the gap between the current condition and the desired state.Create a learning system. People learn in many ways—by being confronted with a worthy challenge, by taking action and reflecting on the results, by using the scientific method, by becoming keen participant observers of their own work processes and the related outcomes, by exchanging ideas and methods about what works and what fails, and so on. It is important to create the learning system and thereby the conditions under which staff members can learn and discover, test out new ideas, realize their own potential, and attempt to innovate.Batalden, P., Nelson, E., Edwards, W., Godfrey, M., & Mohr, J. (2003). Microsystems in Health Care: Part 9. Developing Small Clinical Units to Attain Peak Performance. Joint Commission Journal on Quality and Safety, 29(11), 575-585. Retrieved January 4, 2012, from http://klimik.pbworks.com/f/part9.pdf
Begin with the intention to excel. The particular microsystem, for example a ward in a hospital, must regard the use of personal protective equipment with high importance as a whole system, to create a culture of compliance Involve all the players. All members of the system, management, nursing staff, allied health, must be educated on proper use of personal protective equipment and the correct ways to use it. This understanding and widespread knowledge may help maintain compliance long term. Focus on values that matter. Emphasising the importance and reasoning behind the use of personal protective equipment can help members of the microsystem maintain compliance. Keep both discipline and rhythm. New habits and patterns must be formed, so the standard use of personal protective equipment becomes part of the routine. Use measurement and feedback. Feedback to members of the microsystem about what is being done well and what sill needs work is an important part of maintaining compliance. Create a learning system. Keep education interesting and focused to retain knowledge and compliance.
