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The concept of microsystems in health care organizations stems

Focusing on Microsystems

One useful way for health plans and medical groups to approach the process of improvement is to think of the organization as a system, or more specifically, as a collection of interrelated “microsystems.” The term “microsystems” refers to the multiple small units of caregivers, administrators, and other staff who produce the “products” of health care—i.e., who deliver care and services on a daily basis.

The concept of microsystems in health care organizations stems from research findings indicating that the most successful of the large service corporations maintain a strong focus on the small, functional units who carry out the core activities that involve interaction with customers.1 In the context of health care, a microsystem could be:2

  • A core team of health professionals.
  • Staff who work together on a regular basis to provide care to discrete subpopulations of patients.
  • A work area or department with the same clinical and business aims, linked processes, shared information environment and shared performance outcomes.

Examples of microsystems include a team of primary care providers, a group of lab technicians, or the staff of a call center. In the patient-centered medical home model, a microsystem could be the patient’s care team accountable for coordination of the patient’s services that address prevention, acute care, and chronic care.3

The goal of the microsystem approach is to foster an emphasis on small, replicable, functional service systems that enable staff to provide efficient, excellent clinical and patient-centered care to patients. To develop and refine such systems, health care organizations start by defining the smallest measurable cluster of activities.

Once the microsystems have been identified, a practice or plan can select the best teams and/or microsystem sites to test and implement new ideas for improving work processes and evaluating improvement.5 To provide high-quality care, the microsystem’s services need to be effective, timely, and efficient for all patients,4 and preferably designed in partnership with patients and their families.

Measurement and performance feedback must be part of the microsystem’s principles to learn and improve.6

If a quality improvement intervention is successful for a microsystem, it can then be scaled to other microsystems or the broader organization. However, for successful scalability, organizations should adopt a framework for spread that will work within their structure and culture.