How Do Clinical Microsystems Link to Crossing the Quality Chasm

The first clinical microsystem research was completed by Julie Mohr and Molla Donaldson in 2000 (Donaldson & Mohr, 2000). In this research the success characteristics of high-performing microsystems were first identified. The significance of the microsystem for improving the U.S. health system was called out by Berwick in the chain of effect for improving health care (Figure 1.1, in Chapter One), and this thinking lies behind the Institute of Medicine (IOM) report Crossing The Quality Chasm (Institute of Medicine [U.S.], Committee on Quality of Health Care in America, 2001).

FIGURE 11.4. THE PHYSIOLOGY OF A MICROSYSTEM: A GENERIC MODEL.

Satisfaction of need, monitoring, assessment of outputs-

Entry

Orientation

Initial workup, plan for care

Acute care

Chronic care

Preventive care

Palliative care

Disenrollment

Beneficiary knowledge, including knowledge of life while not in direct contact with the health care system

Functional & risks

Functional & risks

Biological

Functional & risks

Biological

Expectations

Costs

Expectations

Biological

Functional & risks

Biological

Satisfaction

Costs

Satisfaction

Costs

Costs

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