The Benefits of Starting Small: Focusing on Microsystems When Improving Patient Experience

One useful way for health plans and medical groups to approach the process of improvement is to think of the organization as a system, or more specifically, as a collection of interrelated "microsystems." 

The concept of microsystems in healthcare organizations stems from research findings indicating that the most successful large service corporations maintain a strong focus on small, functional units that carry out the core activities involving interaction with customers.¹ In the context of healthcare, a microsystem could be:²

• A core team of health professionals, such as primary care providers.
• Staff who work together on a regular basis to provide care to distinct subpopulations of patients, such as a care team accountable for coordinating patients’ services.
• A work area or department with the same clinical and business aims, linked processes, shared information environment, and shared performance outcomes, such as lab technicians or call center staff.
• A specific clinic or unit of care providers.

The goal of the microsystem approach is to foster an emphasis on small, replicable—and thus scalable—functional service systems that enable staff to provide efficient, excellent clinical and patient-centered care to patients. To develop and refine such systems, healthcare organizations start by defining the smallest measurable cluster of activities.

Once the microsystems have been identified, a practice or plan can select the best teams and/or microsystem sites to test and implement new ideas for improving work processes and evaluating improvement.³ If a quality improvement intervention is successful for a microsystem, it can then be scaled to other microsystems or the broader organization. However, for successful scalability, organizations should adopt a framework for wider implementation that will work within their structure and culture.

The benefit of the microsystem approach is to start small, test the change, and learn from the implementation of the intervention in a small setting. This saves time and money and embeds learning into the process of improvement. At each cycle of the Plan-Do-Study-Act (PDSA) process, as strategies and interventions are moved from one microsystem to additional microsystems, implementation teams learn and can improve the set of strategies (i.e., the intervention) and the process of implementation. This is the essence and foundation of continuous learning. 

^1. Quinn J, Baruch J, Zien K. Innovative Explosion: Using Intellect and Software to Revolutionize Growth Strategies. New York: Free Press; 1997.

^2. Berwick DM. A user's manual for the IOM's 'Quality Chasm' report. Health Aff (Millwood) 2002;21(3): 80-90.

^3. Pronovost P, Weast B, et al. Implementing and validating a comprehensive unit-based safety program. J Patient Saf 2005 Mar;1(1):33-40.