From 2000 to 2002, investigators at the Dartmouth-Hitchcock Medical Center conducted a study to identify and describe the characteristics of exemplary clinical microsystems (i.e., small groups of people in front-line patient care units with a specific clinical purpose).

Key Findings

Findings published in the Joint Commission Journal on Quality Improvement include:

• The microsystems studied shared nine "success characteristics" having to do with:
  • Leadership.
  • Culture.
  • Organizational support.
  • Patient focus.
  • Staff focus.
  • Interdependence of care team.
  • Information and information technology.
  • Process improvement.
  • Performance pattern.
• There was substantial variation in success characteristics across sites.

Key Conclusions

In an action guide intended for managers of health care delivery systems, researchers concluded that high-functioning site teams:

• Are fixated on front-line perfection in meeting patient needs.
• Have a "designed-in" quality such as service excellence, efficiency and timeliness.
• Cross health professional disciplines.
• Have real-time information flow for service and learning — for a helpful, enriched data environment.

Recommendations

In an executive summary of the project intended for health care leaders, researchers offer six recommendations for clinical managers and others, based on their study:

• Focus on enterprise-wide results.
• Provide a few simple rules to 'evaluate' the success of microsystems.
• Create a clear mission and motivation.
• Decentralize accountability.
• Recognize the fundamental nature and power of using microsystem-based approaches.
• Design an information system to support the work of each microsystem and integrate information between microsystems.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $488,806.