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» Microsystems
»  Self-Assessment 
» Practice/Organization Redesign 
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- Assessment Survey
- Best Practice Model
- Chronic Care Model
» Resources

Note

The IOM asserts improvement requires care that is:
- knowledge-based
- patient-centered
- symptoms-minded

Determining Needs and Setting Priorities for Systems Change

IOM Recommendations for Practice Redesign

keyconcept iconClinical 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 three comprehensive redesign principles: that care should be knowledge-based, patient-centered, and systems-minded.4 Self-assessment of a clinical practice could be based on achievement of these principles for redesign.

The report proposes ten new, simple rules as a framework for the enhancement of the effectiveness of health care microsystems. Below each new rule is listed the prevailing and less helpful, current design rule.3

See toolbox below to print out this chart in Adobe Acrobat format.

New Rule
Current Rule
1
Care is based on continuous healing relationships. Care is based primarily on visits.
2
Care is customized according to patients needs and values. Professional autonomy drives variability.
3
The patient is the source of control. Professionals control care.
4
Knowledge is shared freely. Information is a record.
5
Decision-making is based on evidence. Decision-making is based on training and experience.
6
Safety is a system property. "Do no harm" is an individual responsibility.
7
Transparency is necessary. Secrecy is necessary
8
Needs are anticipated. The system reacts to needs.
9
Waste is continuously decreased. Cost reduction is sought.
10
Cooperation among clinicians is a priority. Preference is given to professional roles over the system.

 
Tool Download

Downloadable printoutNew Rules Guideline

Description:
Print out your own copy of the new rules to use as a framework to improve the effectiveness of your system.

Click to download

File Format .pdf
File Size 56k
Download Time: 56k modem <1 minute
Download Time: cable or dsl <10 seconds

IOM Recommendations for Organization Redesign

assessment iconThe 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 in at least six areas, if microsystems are to succeed. Self-assessment of health care organizations could be based on achievement of redesign in these areas.

  1. Better systems for finding best practices and assuring that these best-known clinical models
    become organizational standards.
  2. Better use of information technology to improve access to information and to support clinical decision-making.
  3. Improved workforce knowledge and skills.
  4. More consistent development of effective teams and teamwork.
  5. Better coordination of care among services and settings, both within and among organizations, especially with respect to the care of people with chronic illnesses.
  6. More sophisticated, extensive, and informative measurement of performance and outcomes.

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