By  |  April 27, 2011 | 

“Clinical microsystems are the small,  functional frontline units that provide most health care to most people. They are the essential building blocks of larger organizations and of the health system. They are the place where patients,  families, and careteams meet. The quality and value of care produced by a large health system can be no better than the services generated by the small systems of which it is composed. A seamless, patient centered, high-quality, safe and efficient health system cannot be realized without the transformation of the essential building blocks that combine to form the care continuum.”

Quality By Design-A Clinical Microsystems Approach, E. Nelson et al (ed).

I submit to you that this is our task:  To create, manage and refine the hospital microsystems in which we and our colleagues care for patients–to lead the team.

Whether you are a hospitalist director at a 25-bed critical access hospital or the CMO of a national hospitalist corporation, clinical microsystem teams are the engines that run hospitals and your hospitalists are these systems’ operators.

Once we traverse the collapsing rope-bridge across the  gaping health care chasm, there is no turning back. On the other side, success will be dependent on one factor: our ability to create and maintain  functional clinical microsystems. (For those of you unfamiliar with  microsystem theory, I refer you to Intelligent Enterprise [Quinn 1992]).

Not sure what a functional clinical microsystem looks like? Take a short inventory of your hospital’s “microsystemsness:”

Do clinical staff work with each other to deliver the best possible care to patients?

Are ALL of the frontline health care units (nursing units) running smoothly?

Is important patient information readily available and flowing easily?

Are the health care units seamlessly linked together and are processes standardized across the service line – or is each unit autonomous and independent of the others?

If you answered yes to all four questions, your hospital has  developed a healthy microsystem infrastructure.  If you answered no to any question, keep reading.

The healthcare system is internally combusting. But hospital and healthcare system leaders cannot see the smoke from 30,000 feet. By the time they recognize how serious the situation is on the ground, the system will vaporize.

Day to day,  frontline providers are putting out small fires.  And just like in my son’s favorite Dr. Suess book, Horton Hears a Who, it will take every one of us screaming at the top of our lungs “We are Here!” in order to alert leaders that they need to turn on the hydrants.

As I wrote in my previous post, organized nurses in Massachusetts, Washington DC, Minnesota, New York, California, and Illinois are yelling, “We are here!”  Whether you align yourself with organized labor or not, one cannot deny this call for help. They are crying, “Your hospital is on fire!”

We hospitalists must assemble the bucket brigade. Create the team. Align disparate co-workers. Imagine a healthcare unit where doctors and nurses, pharmacists and phlebotomists, RTs and PTs, and all other healthcare professionals worked together to serve one purpose: to deliver the best possible care to their patients.

My question for you: Will you lead or will you stand by and watch it burn?







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  1. […] YOUR HOSPITAL IS ON FIRE 12:14 am […]

  2. Naser May 18, 2011 at 3:16 pm - Reply

    These are words that are spoken by a very wise person.–:)

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