Quality Management in Healthcare

Question by Professor: There are 8 dimensions of effective Microsystems. Which two (2) do you believe are the most important and why? Please provide examples to illustrate your position.

Don’t forget to cite sources to support your position.

Student 1: Hamala Sharma

Clinical microsystems include patients, clinical staff, processes, and recurring patterns (information flow patterns, results patterns, etc.) that create a sustainable structure for a functional health care system (Mohr, Batalden, & Barach, 2004; Samieim et al., 2011). It consists of people working together to provide care for a specific population of patients; it can vary in size, diversity, and expertise, such as cardiovascular care team, chronic pain management team, etc. (Mohr, Batalden, & Barach, 2004). Clinical microsystems have evolved over the years as the team deals with patients, providers, and external pressure within a complex healthcare system and brings a human face to patients. The eight dimensions of microsystems are all critical for an effective functional team to produce good performance outcomes; however, this discussion will focus on integrating information and technology into workflows and investment in improvements that are a vital part of a microsystem.

Integration of information and technology into the workflow is critical for communication between staff, staff and patients, and staff and other external stakeholders. The information system links timely information sharing for patient care since it connects results from the laboratory, pharmacy notes, medical team notes, shift changes, etc. (Godfrey et al., 2017). Technology has also advanced to monitor and track patients and staff and provide an enhanced reporting system to increase patient safety (Samieim et al., 2011). Integrated information systems reduce time and increase efficiency by improving communication between microsystems and within the macrosystem as a patient moves through a medical facility.

Investment in improvement can be challenging since it usually has a financial cost. At the same time, resources such as training, equipment, time are critical for a medical microsystem to function effectively (Godfrey et al., 2017). At a microsystem level, staff have direct contact with patients daily and see the system's weaknesses and gaps. More importantly, their loyalty is to their patient and the microsystem, and more motivated to make changes (Mohr, Batalden, & Barach, 2004). A work culture that promotes and supports learning and continuous quality improvement for improving patient care also empower staff to focus on patient safety and needs (Samieim et al., 2011). This can benefit the organization.

References

Godfrey, M. M., Foster, T., Johnson, J. K., Nelson, E. C., & Batalden, P. B. (2017). Quality by design: A clinical microsystems approach. John Wiley & Sons, Inc.

Mohr, J., Batalden, P., & Barach, P. (2004). Integrating patient safety into the clinical microsystem. Quality & Safety in Health Care, 13http://0624jawmc.mp03.y.http.dx.doi.org.prx-keiser.lirn.net/10.1136/qshc.2003.009571

Samieim, V., Aniza, I., Sharifa, E., Alsheikh, H. I., Kari H. A., Saleh, M., Sengee, G., & Waruegh, N., (2011) CLINICAL MICROSYSTEM APPROACH-A METHOD FOR HEALTH CARE IMPROVEMENT. Malaysian Journal of Public Health Medicine, Vol. 11(1): 16-28. https://www.mjphm.org.my/mjphm/journals/Volume%2011:1/176-11-TO%20PUBLISH.pdf

Student 2: Dabin Jung

Out of the 8 dimensions of effective microsystems, I think interdependence of the care team to meet patient needs and ongoing measurement of outcomes are the most important dimensions.

The team is one of the components that make up the active implementation framework (Johnson & Sollecito, 2020). People work together for specific and patient-centered goals in a team. The team is an accountable structure that is needed for implementing plans, identifying, and successfully solving problems, and sustaining quality care for populations and the individual patient. Organizing a health care professional team is essential and excellently teamwork results in quality care that is safe and reliable (Rosen et al., 2018).

Ongoing measurement of outcomes is an essential procedure for health systems to know the effectiveness of their care for their patients. It is one of the CQI tools and techniques which leads to improvements and greater outcomes (Johnson & Sollecito, 2020). Outcome measurements are done in various ways. One method of measuring outcomes is by giving out questionnaires. One study tested out a way to develop and experiment with a tool to measure CQI and outcome in Swedish healthcare (Andersson et al., 2013). The study used a method of distributing questionnaires after each care, and they could see patients’ overall satisfaction and quality improvement (Andersson et al., 2013). By yielding positive outcomes, ongoing measurement of outcomes is a critical dimension that makes up effective microsystems.

Andersson, A. C., Elg, M., Perseius, K. I., & Idvall, E. (2013). Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare. BMC Health Service Research. 13(48). https://doi.org/10.1186/1472-6963-13-48.

Johnson, J. K. & Sollecito, W. A. (2020). McLaughlin and Kaluzny’s continuous quality improvement in health care (5th ed.). Jones & Bartlett Learning.

Rosen, M. A., Granados, D. D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist. 73(4), 433–450. https://doi.org/10.1037/amp0000298.