Clinical Microsystems, Part 1. The Building Blocks of Health Systems

被引：123

作者：

Nelson, Eugene C. ^{[1
,2
]}

Godfrey, Marjorie M. ^{[3
,4
,5
]}

Batalden, Paul B. ^{[6
,7
,8
]}

Berry, Scott A. ^{[9
]}

Bothe, Albert E., Jr. ^{[10
]}

McKinley, Karen E. ^{[9
]}

Melin, Craig N. ^{[11
,12
]}

Muething, Stephen E. ^{[13
,14
]}

Moore, L. Gordon ^{[15
,16
,17
]}

Wasson, John H. ^{[19
,20
,21
]}

Nolan, Thomas W. ^{[18
]}

机构：

[1] Dartmouth Med Sch, Dept Community & Family Med, Hanover, NH 03755 USA

[2] Dartmouth Hitchcock Med Ctr, Qual Adm, Lebanon, NH 03766 USA

[3] Dartmouth Med Sch, Community & Family Med, Hanover, NH USA

[4] Inst Healthcare Improvement, Cambridge, MA USA

[5] Vermont Oxford Network, Burlington, VT USA

[6] Dartmouth Med Sch, Dartmouth Inst Hlth Policy & Clin Practice, Dept Pediat, Lebanon, NH USA

[7] Dartmouth Med Sch, Dartmouth Inst Hlth Policy & Clin Practice, Dept Community & Family Med, Lebanon, NH USA

[8] Dartmouth Med Sch, Dartmouth Inst Hlth Policy & Clin Practice, Ctr Leadership & Improvement, Lebanon, NH USA

[9] Geisinger Hlth Syst, Clin Effectiveness, Danville, PA USA

[10] Geisinger Hlth Syst, Geisinger Med Ctr, Danville, PA USA

[11] Cooley Dickinson Hosp, Northampton, MA USA

[12] Dartmouth Med Sch, Dartmouth Inst Hlth Policy & Clin Practice, Hanover, NH USA

[13] Cincinnati Childrens Hosp Med Ctr, Patient Safety Hlth Policy & Clin Effectiveness, Cincinnati, OH 45229 USA

[14] Cincinnati Childrens Hosp Med Ctr, Gen & Community Pediat, Cincinnati, OH 45229 USA

[15] Univ Rochester, Ideal Med Practices Project, Rochester, NY USA

[16] Univ Rochester, Dept Family Med, Rochester, NY USA

[17] Univ Rochester, Dept Community & Prevent Med, Rochester, NY USA

[18] IHI, Execut Team, Cambridge, MA USA

[19] Dartmouth Med Sch, Dept Community & Family Med, Geriatr, Hanover, NH USA

[20] Dartmouth Med Sch, Dept Med, Geriatr, Hanover, NH USA

[21] IHI, Off Practice IMPACT Network, Cambridge, MA USA

来源：

JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY | 2008年 / 34卷 / 07期

关键词：

D O I：

10.1016/S1553-7250(08)34047-1

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Wherever, however, and whenever health care is delivered-no matter the setting or population of patients-the body of knowledge on clinical microsystems can guide and support innovation and peak performance. Many health care leaders and staff at all levels of their organizations in many countries have adapted microsystem knowledge to their local settings. Clinical Microsystems: A Panoramic View: How Do Clinical Microsystems Fit Together? As the patient's journey of care seeking and care delivery takes place over time, he or she will move into and out of an assortment of clinical microsystems, such as a family practitioner's office, an emergency department, and an intensive care unit. This assortment of clinical microsystems-combined with the patient's own actions to improve or maintain health- can be viewed as the patient's unique health system. This patient-centric view of a health system is the foundation of second-generation development for clinical microsystems. Lessons from the Field: These lessons, which are not comprehensive, can be organized under the familiar corn mands that are used to start a race: On Your Mark, Get Set, Go! . . . with a fourth category added-Reflect: Reviewing the Race. These insights are intended as guidance to organizations ready to strategically transform themselves. Conclusion: Beginning to master and make use of microsystem principles and methods to attain macrosystem peak performance can help us knit together care in a fragmented health system, eschew archipelago building in favor of nation-building strategies, achieve safe and efficient care with reliable handoffs, and provide the best possible care and attain the best possible health outcomes.

引用

页码：367 / 378

页数：12

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