Clues to Better Health Care May Come from Studying Small Details, Not the Big Picture

From 1999 to 2000, National Academy of Sciences - Institute of Medicine (IOM) conducted a study of high-performing micro-systems—small, organized patient care units with a specific clinical purpose, set of patients and practitioners—within health care institutions or systems.

The study was part of a larger IOM initiative on the Quality of Health Care in America, the goal of which was to develop recommendations for improving the overall US health care system.

The study was based on interviews with the leaders of 43 micro-systems.

Key Findings

In their report, entitled Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross Case Analysis, the investigators identified six factors that may be key to replicating a high-performing micro-system:

  • Senior executives and management support innovation and improvement efforts.
  • Clinical leadership is strong, focused and sustained.
  • Multi-disciplinary teams collaborate both for clinical care and for improvement efforts.
  • Explicit attention is paid to the development of systems of care.
  • Good information systems make measurement of performance possible.
  • The focus is on the needs of patients.


They also identified eight themes that typify high-performing micro-systems:

  • Information from a variety of sources is integrated into the daily work.
  • Performance measures have been developed and are used to modify patient care.
  • Key players work as a collaborative multidisciplinary team.
  • The aims of the micro-system are consistent with those of the larger system.
  • Clear aims guide work and are communicated across micro-system boundaries.
  • The micro-system is a resource for the community and vice versa.
  • Training, money and time are available for making improvements.
  • There is high alignment between health professionals' roles and qualifications.