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).
Findings published in the Joint Commission Journal on Quality Improvement include:
- The microsystems studied shared nine "success characteristics" having to do with:
- 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.
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.
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.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $488,806.
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