Understanding the complexity of redesigning care around the clinical microsystem

Abstract

The microsystem is an organizing design construct in which social systems cut across traditional discipline boundaries. Because of its interdisciplinary focus, the clinical microsystem provides a conceptual and practical framework for simplifying complex organizations that deliver care. It also provides an important opportunity for organizational learning. Process mapping and microworld simulation may be especially useful for redesigning care around the microsystem concept. Process mapping, in which the core processes of the microsystem are delineated and assessed from the perspective of how the individual interacts with the system, is an important element of the continuous learning cycle of the microsystem and the healthcare organization. Microworld simulations are interactive computer based models that can be used as an experimental platform to test basic questions about decision making misperceptions, cause-effect inferences, and learning within the clinical microsystem. Together these tools offer the user and organization the ability to understand the complexity of healthcare systems and to facilitate the redesign of optimal outcomes.

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

“…Session one of ''Teaching on Today's Wards'' takes the Faculty Scholars through an exploration of their teaching process on a postcall day using process mapping. 29,30 This technique, similar to constructing a flow chart, involves outlining the series of steps involved in one's actual (not ideal) process of postcall teaching. Faculty Scholars then explore how to recognize opportunities and add geriatric topics and the ACGME core competencies to their teaching on the basis of their own teaching process, skill sets, and clinical experience.…”

Health care: a case of hypercomplexity?

“…Baxter (2010) acknowledges that "the importance of complexity in health care systems is widely recognised" (p. 7), but observes that within this overall consensus there is a range of views on the nature of healthcare system complexity: he contrasts the view of healthcare systems as complex adaptive systems (espoused, for example, by Plesk & Greenhalgh, 2001) which need to be addressed by the methods of complexity science with other, less formal, depictions of healthcare complexity. For Barach and Johnson (2006) the implication of healthcare systems as complex adaptive systems is that they are collections "of individuals who are free to act in ways that are not totally predictable" (p. i10). Runciman, Merry and Walton (2007) suggest that the key differences about healthcare complexity are the diversity of tasks within healthcare systems, the vulnerability of many patients, and healthcare activity patterns, "which often have a great deal of immediate human involvement with high safety-criticality, with respect to uncertainty, and with respect to… lack of regulation" (p. 111).…”

Building Clinical and Organizational Resilience to Reconcile Safety Threats, Tensions and Trade-Offs: Insights from Theory and Evidence

“…It is at this level that clinicians are faced with high levels of uncertainty in their daily work -uncertainty that impacts the quality and safety of care that patients receive (Tucker and Spears 2006). Thus, it is paramount that attention be paid to system vulnerabilities at the clinical and organizational interface to enhance our understanding of how to reconcile safety threats in healthcare (Barach and Johnson 2006). As part of this understanding, we require insight into the more complex and deeply structured organizational systems inherent in healthcare processes (Waring et al 2006).…”

“…There are four key components that define the nature of microsystems: (1) patients for whom care is provided, (2) professionals providing the care, (3) processes the microsystem uses to provide services and (4) patterns that characterize the microsystem functioning (Barach and Johnson 2006;Godfrey et al 2003). Microsystems evolve over time in response to the balancing act of healthcare professionals meeting patient needs within the context of work processes and patterns specific to the environment in which they provide care (Barach and Johnson 2006). Relating this balancing act to patient safety, the clinical microsystem is where patients, practitioners and patterns of practice interact to determine the safety of care processes (Espin et al 2006a) and their response to emergent safety threats.…”