TY - JOUR
T1 - Microsystems in health care
T2 - Part 1. Learning from high-performing front-line clinical units
AU - Nelson, Eugene C.
AU - Batalden, Paul B.
AU - Huber, Thomas P.
AU - Mohr, Julie J.
AU - Godfrey, Marjorie M.
AU - Headrick, Linda A.
AU - Wasson, John H.
N1 - Funding Information:
The authors thank the staff in the 20 clinical systems ( Appendix 1 , p 493) for teaching so much about what can be done to innovate and provide superior care to patients and community residents. They also express their appreciation for the extensive contributions made by Kerri Ashling, MD, Richard Brandenburg, PhD, and Valerie Stender, RN, in medical record review, financial, and operational analyses. The authors are very grateful to the Robert Wood Johnson Foundation for its generous support of this investigation, (RWJ Grant Number 036103 ). They deeply appreciate the guidance and inspiration provided by Professor J. Brian Quinn, PhD. Finally, they acknowledge the encouragement and ideas offered by Donald Berwick, MD, and his colleagues at the Institute for Healthcare Improvement.
PY - 2002/9
Y1 - 2002/9
N2 - BACKGROUND: Clinical microsystems are the small, functional, front-line units that provide most health care to most people. They are the essential building blocks of larger organizations and of the health system. They are the place where patients and providers meet. The quality and value of care produced by a large health system can be no better than the services generated by the small systems of which it is composed. METHODS: A wide net was cast to identify and study a sampling of the best-quality, best-value small clinical units in North America. Twenty microsystems, representing different component parts of the health system, were examined from December 2000 through June 2001, using qualitative methods supplemented by medical record and finance reviews. RESULTS: The study of the 20 high-performing sites generated many best practice ideas (processes and methods) that microsystems use to accomplish their goals. Nine success characteristics were related to high performance: leadership, culture, macro-organizational support of microsystems, patient focus, staff focus, interdependence of care team, information and information technology, process improvement, and performance patterns. These success factors were interrelated and together contributed to the microsystem's ability to provide superior, cost-effective care and at the same time create a positive and attractive working environment. CONCLUSIONS: A seamless, patient-centered, high-quality, safe, and efficient health system cannot be realized without the transformation of the essential building blocks that combine to form the care continuum.
AB - BACKGROUND: Clinical microsystems are the small, functional, front-line units that provide most health care to most people. They are the essential building blocks of larger organizations and of the health system. They are the place where patients and providers meet. The quality and value of care produced by a large health system can be no better than the services generated by the small systems of which it is composed. METHODS: A wide net was cast to identify and study a sampling of the best-quality, best-value small clinical units in North America. Twenty microsystems, representing different component parts of the health system, were examined from December 2000 through June 2001, using qualitative methods supplemented by medical record and finance reviews. RESULTS: The study of the 20 high-performing sites generated many best practice ideas (processes and methods) that microsystems use to accomplish their goals. Nine success characteristics were related to high performance: leadership, culture, macro-organizational support of microsystems, patient focus, staff focus, interdependence of care team, information and information technology, process improvement, and performance patterns. These success factors were interrelated and together contributed to the microsystem's ability to provide superior, cost-effective care and at the same time create a positive and attractive working environment. CONCLUSIONS: A seamless, patient-centered, high-quality, safe, and efficient health system cannot be realized without the transformation of the essential building blocks that combine to form the care continuum.
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U2 - 10.1016/S1070-3241(02)28051-7
DO - 10.1016/S1070-3241(02)28051-7
M3 - Article
C2 - 12216343
AN - SCOPUS:0036718125
SN - 1553-7250
VL - 28
SP - 472
EP - 493
JO - Joint Commission Journal on Quality and Patient Safety
JF - Joint Commission Journal on Quality and Patient Safety
IS - 9
ER -