Determining Needs and Setting Priorities for Systems Change

Microsystems

Clinical practices can be viewed as microsystems that produce services for specific patient populations.1 2 3 The Institute of Medicine's Quality Chasm report asserts that achieving improvement will require redesigns of these small units of work and suggests the following three comprehensive redesign principles. Clinical care should be:

• knowledge-based
• patient-centered
• systems-minded.4

Self-assessment of a clinical practice could be based on achievement of these principles for redesign.

The organizations (hospitals, multispecialty group practices, integrated delivery systems) that house microsystems, need to provide the tools and the support necessary for the work conducted in the microsystems. The IOM Quality Chasm report identifies major gaps in the quality of today's health care organizations. The report recommends that health care organizations need better designs if microsystems are to succeed. Self-assessment of health care organizations should be based on the need for system redesign.

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