Those of you in the nicu are by now familiar with the term “microsystem”, though you may not know what it means or what the project is meant to accomplish. I clinical microsystem is a group of individuals who are engaged together in the delivery of medical care. It thus includes not just providers, but also support Ppersonnel, patients and families. Applying systems thinking to this group at the interface of clinical care allows us to identify characteristics of high performing, quality microsystems. For over two decades, the Microsystems project at Dartmouth has studied high performing microsystems and has not only identified critical success factors, but also developed methods that help to bring about transformation into such high performing units.
The microsystem method starts with the assembly of a group of individuals representing the microsystem itself. As many stakeholders as possible should be represented, although patients and families are not typically directly engaged in the change effort. The group (typically 10-12 people) meet together on a regularl (usually weekly basis), and embrace best meeting practices. For example, all members of the group are called by their first names, and all are treated with equal respect during meetings. The meeting leader rotates with each meeting, and a facilitator is charged with assuring that no one dominates the discussion; quiet individuals are specifically prompted for their opinions. The group brainstorms in non-challenging ways to solve problems. The group pursues a change “ramp” that begins with assessing the microsystem with regard to its Purpose, its Professionals, its Patients, its Processes (what work is actually done), and its Patterns (how the culture works). Assessing the culture can be particularly enlightening, as light is cast on both favorable and unfavorable behaviors that may lie beneath the surface of the organization.
Once the team assesses the microsystem, it is charged with identifying an area in which to focus change, then select a specific aim or project, and begin plan-do-study-act cycles that will attempt to improve the area selected. If the effort is successful, the group is perpetuated and moves from aim to aim and project to project. Microsystem groups that work benefit from the engagement of personnel at all levels of the organization, realizing the creativity and commitment that lies within individuals in any role.
The NICU Microsystem Project has been underway since October, and is just completing a staff survey, the results of which will soon be made available. We have put together a bulletin board outside the NICU nurses’ conference room that will track the project. Look for reports on the effort.
As the NICU project matures, we will be forming additional microsystem teams in other parts of the Children’s Hospital. If you are interested in learning more, see this link. I hope many of you will join one of these teams and help make the Children’s Hospital ever better.
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