John H. Wasson, Marjorie M. Godfrey, Eugene C. Nelson, Julie K. Johnson, Paul B. Batalden
Background. Clinical microsystems are the essential building blocks of all health systems. At the heart of an effective microsystem is a productive interaction between an informed, activated patient and a prepared, proactive practice staff. Support, which increases the patient's ability for self-management, is an essential result of a productive interaction. This chapter describes how high-performing microsystems design and plan patient-centered care.
Planning patient-centered care. Well-planned, patient-centered care results in improved practice efficiency and better patient outcomes. However, planning this care is not an easy task. Excellent planned care requires that the microsystem have services that match what really matters to a patient and family and protected time for staff to reflect and plan. Patient self-management support, clinical decision support, delivery system design, and clinical information systems must be planned to be effective, timely, and efficient for each individual patient and for all patients.
Conclusion. Our study of twenty high-performing clinical microsystems demonstrated that excellent planned services and planned care are attainable today in microsystems that understand what really matters to a patient and family and have the capacity to provide services to meet each and every patient's needs.
Effective microsystems are designed with the patient, or recipient, in mind
(Nelson et al., 2002). Today many of the most progressive microsystems design care or improve their existing design of care not only with the patient in mind, but also with patients and families serving as full members of the team. These exemplary microsystems know how to make their services best meet the needs of the distinct subpopulations they serve. In this chapter we focus on the way effective microsystems individualize their services (and sometimes the services offered by other microsystems in the macrosystem or the community as well) to best meet a patient's needs.
In Chapter Six we described how microsystem awareness of the 5 P's— purpose, patients, professionals, processes, and patterns—can result in greater efficiency. Planned services result in less unwanted variation and waste, smoother process flow, more effective use of information, and better matching between staff roles and work.
This chapter describes how a self-aware microsystem can ground efficient services in the patient-centered planned care model. Planned care results in productive patient-provider communication and improved patient self-management. The natural synergy between planned services and planned care results in doing it right the first time for every single patient.
Decades of clinical research confirm the power of productive interactions between informed, activated patients and clinical staff. This research is summarized in a planned (or chronic) care model (Bodenheimer, Wagner, & Grumbach, 2002a, 2002b). The planned care model has several critical components that support a productive interaction (Figure 7.1), and there is considerable overlap between the planned care model and the microsystem framework. In an effective microsystem, self-management support, decision support, delivery system design, and clinical information systems are planned to be effective, timely, and efficient for each individual patient and for all patients. In an effective microsystem, planned services evolve to fit the care needs of an individual patient like a glove fits a hand.
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