Success Characteristics of High Performing Sites

Analysis of the results suggests that each of the twenty high-performing clinical units is indeed a complex, dynamic system, with interacting elements that come together to produce superior performance. No single feature or success characteristic can stand alone to produce high-quality, high-value systemic results. That being said, these microsystems shared a set of primary success characteristics, and these characteristics interacted with one another to produce highly favorable systemic outcomes:

• Leadership of microsystem

• Macrosystem support of microsystem

• Patient focus

• Interdependence of care team

• Information and information technology

• Process improvement

• Performance results

These primary success characteristics fall into five main groups and interact dynamically with one another. Figure 1.5 displays these groupings. It also shows two additional success characteristics that involve health professional education and training and the external environment (including the financial, regulatory, policy, and market environments) in which the microsystem is embedded. These themes were often mentioned in our research, although not as frequently as the primary ones we identified. A third additional theme, patient safety, was also identified, but again in a less frequent pattern so it was not included in the final success characteristics.

Content analysis of the interview text showed that seven of the eight primary success characteristics were mentioned frequently. For example, process improvement methods were mentioned in 13.5 percent of all text units coded, and staff focus was mentioned in 9.4 percent. Organizational support of microsystem (3.2 percent) was important but less frequently mentioned.

FIGURE 1.5. SUCCESS CHARACTERISTICS OF HIGH-PERFORMING CLINICAL MICROSYSTEMS.

FIGURE 1.5. SUCCESS CHARACTERISTICS OF HIGH-PERFORMING CLINICAL MICROSYSTEMS.

There was substantial variation in the prominence of the primary success characteristics across sites. For example, leadership, which accounted for 7.7 percent of the coded comments on average, ranged from a high of 13.2 percent in a nursing home to a low of 3.1 percent in a home health site. Similarly, staff focus, which accounted for 9.4 percent of coded comments on average, ranged across sites from a high of 20.9 percent in a home health unit to 1.6 percent in a specialty medicine unit. This variation suggests that different clinical units in different contexts serving different types of patients may possess these success characteristics in greater or lesser degrees.

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