Despite significant investments to improve the quality of care for hospitalized patients, the existing evidence suggests that progress has been slower than desired.1-6 Most adults requiring hospitalization are admitted for medical conditions,7,8 yet the optimal model of care for these patients is yet to be determined.9 Teams caring for medical patients are large, with membership that continually evolves because of the need to provide round-the-clock care. Physicians are often spread across multiple units and floors and have little opportunity to develop relationships with other professionals who work on designated units (e.g. nurses). Patients and family members are generally poorly informed and lack opportunities to engage in decision making. As a result, medical services lack the structure and shared accountability necessary to improve performance over time. A growing body of research has tested interventions to redesign aspects of care delivery for hospitalized medical patients. These interventions address the challenges mentioned above and include geographic localization of physicians to specific units,10-13 unit co-leadership,14,15 and inter-professional rounds.16,17 The evidence that these interventions improve outcomes is equivocal, but most studies have reported their effect in isolation. These interventions may be better conceptualized as complementary components of a redesigned clinical microsystem. A clinical microsystem is defined as the small group of people who work together in a defined setting on a regular basis to provide care. Effective clinical microsystems have clinical aims, linked processes, a shared information environment, and measure performance outcomes. High-value organizations deliberately design clinical microsystems to optimize their performance.18,19 Members of our research team previously implemented a set of complementary interventions, redesigning clinical microsystems across 7 medical units at Northwestern Memorial Hospital. The
|Effective start/end date
|9/30/17 → 1/31/23
- Agency for Healthcare Research and Quality (5R18HS025649-05 Revised)
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