Application of clinical microsystem concepts to improve health services delivery: Examples from practice, research, and education

Organizational learning and information play a major role in addressing the critical public health challenge of improving health service delivery. In this presentation we discuss how the growing body of knowledge about clinical microsystems can be used to leverage both of these strategies to plan and redesign systems of care to improve population health outcomes. The clinical microsystem model is based on complexity science, which is being used nationally and internationally to guide health system performance improvement initiatives. A complexity-inspired worldview moves beyond the mechanistic paradigm where health services are considered rational predictable bureaucracies to a biological paradigm more consistent with today's complex health care environment. Health services are managed and respected as living, adaptable, changing systems that produce outcomes by ongoing learning, feedback, individual actions, and interactions in relationships. Using the clinical microsystem to design and improve care requires making relationships between “5 Ps” explicit – purpose, patients, professionals, processes, and patterns. The essential role that information plays in connecting these clinical microsystem elements is illustrated by four case studies in which service delivery problems were addressed using microsystem modeling and complexity science principles including opening the flow of information to improve interdisciplinary team care, data sharing to guide a public health improvement learning collaborative, using a flow diagram to improve in-home geriatric primary care, and using information process monitoring to teach students to analyze system gaps. Take-away lessons include insights about designing information systems to inform and improve the delivery of population health services.