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:
- 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.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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