What Front-Line Caregivers Need to Succeed

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.


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.