Whether providers and patients know it or not, they are all potentially members of a "clinical microsystem," a crucial component in improving health care quality. Since people make up most of its components, how can the microsystem be optimized for workforce development?
First, some fundamentals, based in part on the work of the Institute for Healthcare Improvement and colleagues at Dartmouth-Hitchcock Medical Center (Lebanon, New Hampshire, USA). A clinical microsystem is a small, interdependent group of people who work together regularly to provide care for specific groups of patients. This small group is often embedded in a larger organization. Formed around a common purpose or need, these groups may comprise discrete units of care, such as a neonatal intensive care unit or a spine center. A general clinical microsystem includes, in addition to doctors and nurses, other clinicians, some administrative support and a small population of patients, with information and information technology as critical "participants."
A clinical microsystem, then, has a common aim, a subpopulation of patients, shared work processes, a shared information environment, and exists within a larger organizational environment — one that can help or harm the functioning of the smaller system. The best health care services result when their component microsystems are functioning optimally. Thus, learning what is most important to the people who make up the microsystem is key to continuous improvement and best quality outcomes.
A microsystem can be optimized through attention to a number of factors. One of these is assessing the
people. Managers need to determine: who is in the microsystem, how they are spending their time, and how they view the quality of their worklife.
Activity analysis allows for real data about how staff spend their time, and the results can be used to redesign and optimize their roles. A 12-item survey questionnaire using a 4-point scale ranging from “strongly agree” to “strongly disagree,” administered every 6 to 12 months, provides ongoing results to feed back into improvement efforts. Data at the extreme ends of the scale provide a view of what managers need to maintain (items rated "strongly agree") and what they need to strengthen (any areas not labeled as "strongly agree"). [See the
Workforce Presentation materials on the Clinical Microsystems website for more information on the 12-item survey.]
So now you know what they think — what can you do about it? The "diagnosis" is made through the survey instrument; now you need to institute "treatment," i.e., improve worklife for the staff. One model of achieving this aim incorporates the 12 questions in the survey and is analogous to climbing a tall mountain.
At "base camp," microsystem members need to know the basics about their worklife: what is expected of them, with materials and equipment they need to fulfill their roles provided. As they ascend the summit, they move from the “what do I get?” orientation of base camp, to the “what do I give?” stance of Camp One. People at this level need recognition for good work, care, and encouragement.
As members of the microsystem approach Camp Two, they are asking themselves whether they belong in the group. They need to know that their opinions matter, that their jobs are important, and that their co-workers are committed to the same high-quality work.
Impatience of a sort marks Camp Three. Members are focused on learning and improving, and they want everyone in the microsystem to improve, too. Progress and opportunities for learning are the hallmarks of satisfaction in this stage.
Finally, the summit is reached when all the people in the microsystem have a clear focus, a recurring sense of achievement, and the group, undergirded by a sense of mutual understanding and shared purpose, is enabled to embrace new challenges.
Further Reading:
The Clinical Microsystems website also contains the following:
