Microsystem Tools for Health Care
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Microsystem Tools for Health Care
- 1. Microsystems in Health Care: Tools for Application Hloniphani Juta Rachel Duffy Lara Kesteloo Macrosystem Microsystem Tools
- 2. Microsystem Tools Elements of a Microsystem in Health Care Health professional team Defined target population Knowledge support Support staff, equipment and working environment
- 3. Microsystem Tools Tools used in Health Care 5 P Tool Clinical Microsystem Assessment Tool Clinical Compass Worksheet • A way to ensure that teams gather a • Used to identify a microsystems areas of • A balanced approach to measuring and comprehensive understanding of their functioning strengths and developmental improvements. displaying value. and can identify areas of development. • Definitions of characteristics and three functional • Four points: functional, satisfaction, costs and • Purpose, Patients, People, Processes and levels within clinical aspects of health care. Patterns . Leadership, staff, patients, performance, and information technology. Clinical Improvement Worksheet STAR Mapping Worksheet • A 6-step flow chart to implement • Prediction of future relationships change at the microsystem level. or improvement of existing ones. • S- Separateness • T- Talking • A- Action • R-Reason
- 4. Microsystem Clinical Improvement Tools Worksheet: Aim: A Closer Look “To accelerate clinical improvement by linking outcome measurements, structures, process and pattern knowledge with the design and implementation knowledge of pilot tests of change.” (Godfrey, Nelson, Batalden, Wasson, Mohr, Huber, & Headrisk, 2004, p. 136) Outcomes Pilot Process Changes Patterns Structure
- 5. Microsystem Tools Case Study Care delivery model redesign (CDMR) roll out for Vancouver Island Health Authority (VIHA) A bottom-up improvement design (Unit System) Clinical Improvement Worksheet application Aim: To maintain pre-hospitalization
- 6. Microsystem Tools Clinical Improvement Worksheet and the CDMR •Select Population: All Admissions Outcomes •Goal: To maintain pre-hospitalization function of patients and optimize care. •Analyze: Bottom-up process with change initiated at the unit level Process through a redesign of assessment forms and the implementation of 48/6 •Knowledge of pre-hospitalization status is unacceptable •Identify patterns: ie. Lack of staff or time, poor assessments, no Patterns continuity •Consider working relationships, meetings and previous changes made •Actual setting: Diverse cultures Structure •What and who is/are present? •Ideas for change: Care delivery model redesign – routes for change ie. Changes 48/6 and new assessment sheets. •Roll out Pilot •Implement PDSA method to direct change
- 7. Microsystem Tools REFERENCES Godfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving your microsystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdf Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources. Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061 Stevenson, L. (Vancouver Island Health Authority). (2010, March 30-31). Care delivery model redesign [PDF file]. Retrieved from http://www.chspr.ubc.ca/files/publications/2010/conference/Stevenson,Lynn.pdf
- 8. Search Microsystem Tools Strategies to get oriented by finding an Our goal was overview of microsystems then to find a small number of tools used by microsystems with relation to heath care then to chose one tool and apply it to a case study. This narrowed our search dramatically, especially with the focus on health care. Once the tools were found it was merely a matter of synthesizing a general knowledge of the tools we are mentioning with a deeper knowledge of a single
- 9. Collaboration Microsystem Tools Process Once the scope of our portion of the presentation was determined, we split the work into three parts: 1. Overview of Microsystems to give us background knowledge (Juta) 2. Overview of some tools used by microsystems with relation to health care (Rachel) 3. Case study, PowerPoint development, references and fine-tuning (Lara)
Notas del editor
- ReferencesNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
- Definition of Microsystems in Health Care: “Microsystems are a unique part of the health system and they are composed of people who come together to care for a defined population of patients,” (Nelson,Mohr, Batalden & Plume, 2000).Microsystems produce quality, safety and cost outcomes at the front line of care.Microsystems: caregivers, clinical and administrative support persons, information technology and patients.ReferencesNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
- 5 P’sMicrosystems use the 5p tool as a way to ensure that teams gather a comprehensive understanding of their functioning and can identify areas of development.Purpose of the microsystemPatients are the focus of the microsystemPeople who work together in the micro systemProcesses the Microsystems uses to provide carePatterns that characterise the MicrosystemsClinical Microsystem Assessment Tool -The Clinical Microsystem Assessment tool can be used in health care to identify a microsystems areas of strengths and developmental improvements. This tool provides a definition of each success characteristic and three descriptions with a range of low functioning to high performing behaviours. Leadership, staff, patients, performance and information and information technology are the areas assessed by the tool. Recommended use of the tool includes explaining to the staff/people of the clinical microsystem the background of clinical microsystems and to then ask each member of the staff to rate each characteristic, thinking of the clinical microsystem they work in everyday. Use the findings to guide selection of aspects of the clinical microsystem that appear to be top priorities for recognition and those that appear to be critical for improvement. A plan for change within the microsystem can be developed based on the results of the assessment.Clinical Compass Worksheet- Clinical Value Compass Worksheet- Another tool used in the health care setting is the “Clinical Value Compass Worksheet”. It is a worksheet that is set out like a compass, and each point on the compass focuses on a different element of the health care system- functional, satisfaction, costs and clinical. The Clinical Value Compass presents a balanced approach to measuring and displaying value in health care. It is a measurement system that is designed for identifying and monitoring those keyindicators of care that enable one to assess the quality of health care.North - functional status, risk status, and well-being.South - the cost of the care delivered, including medical expenses, lost days of work, and other non-health care costs incurred by the patient and his or her family.East - the patient's satisfaction with and expectations of health care.West - the presenting clinical problem and its manifestations.Clinical Improvement Tool – will describe later in this presentation through the application of a case study.STAR Mapping Worksheet- This tool was talked about briefly last week, we’ll just go through it again, as it is a valuable tool within microsystems, and gives users an opportunity to improve working relationships. The STAR mapping worksheet is useful when exploring relationships across boundaries and is based on improved tuning and intentional action, with a focus on improving patient care. The STAR mapping worksheet is similar to the clinical value compass worksheet- there are four points on the star and each point represents a different element of the working relationshipS - Separateness or Differences to allow for “facts” to be seen as “interpretations”T - Tuning - talking and listening opportunities to challenge status quo and implicit assumptions -+ve affect and precisionA - Action opportunities - Permission or potential to act or create something newR - Reason to work together - Mutual BenefitsReferencesGodfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving yourmicrosystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdfNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.Nelson, E. C., Mohr, J. J., Batalden, P. B., & Plume, S. K. (1996). Improving health care, part 1: The clinical value compass. The Joint Commission Journal on Quality Improvement, 22(4), 243-258. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8743061
- Is similar to a flow chart directing change over 6 steps.1) Outcomes:Select a populationWhat is the general aim/results?2) Process:Analyze the processWhat is the process for giving care to this type of patient?3) Patterns:Identify the common patterns at workConsider working relationshipsDo you meet regularly?Have you successfully changed anything?What patterns can you identify?4) Structure:Visualize the actual settingWhat and who is there?5) Changes:Develop ideas for changeWhat are the ideas for creating change?6) Pilot:Select change to pilot testImplement PDSA method to direct changeReferencesGodfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving yourmicrosystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdf
- ReferencesStevenson, L. (Vancouver Island Health Authority). (2010, March 30-31). Care delivery model redesign [PDF file]. Retrieved from http://www.chspr.ubc.ca/files/publications/2010/conference/Stevenson,Lynn.pdf
- 1) Outcomes:Select a population: All patientsWhat is the general aim/results? To maintain pre-hospitalization function of patients and optimize care2) Process:Analyze the process: Bottom-up process with change initiated at the unit level through a redesign of admission assessment forms, during care and discharge including the implementation of 48/6.What is the process for giving care to this type of patient? Currently knowledge of pre-hospitalization status is unacceptable and often leads to patients leaving the hospital with less functioning than they had when entering3) Patterns:Identify the common patterns at work: Lack of staff, lack of time, admission and inpatient assessment sheets have no continuity across units and do not address pre-hospital functioning appropriately.Consider working relationships: Often strained, opposing pressures from top-down management, differences in training.Do you meet regularly? Some unitsHave you successfully changed anything? Depends on the changeWhat patterns can you identify?4) Structure:Visualize the actual setting: All Units – diverse cultures, all have basic equipment but vary from there.What and who is there? Elderly are most common and the most likely to leave with reduced functioning due to vulnerability, social constructs, etc.5) Changes:Develop ideas for change: Care Delivery Model Redesign – redesign how care is delivered. Accomplished through multiple routes. One being 48/6.What are the ideas for creating change? New admission, inpatient and discharge assessment sheets. 48/6 for getting to know the real patient within an acceptable amount of time.Etc6) Pilot: Roll out 48/6 and redesigned assessment sheetsSelect change to pilot testImplement PDSA method to direct changeReferencesGodfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving yourmicrosystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdfStevenson, L. (Vancouver Island Health Authority). (2010, March 30-31). Care delivery model redesign [PDF file]. Retrieved from http://www.chspr.ubc.ca/files/publications/2010/conference/Stevenson,Lynn.pdf