The following description of the 5 P's is essential information for microsystem leaders. Moreover, by sharing this information with everyone in the microsystem, leaders can promote learning, understanding, and awareness that is broad and deep; this improves the functioning of your microsystem.
The purpose of your microsystem may go beyond the microsystem's mission statement. If a mission statement is available, then consider having an active discussion among all the microsystem members to enable each person to make a connection between himself or herself and his or her values on the one hand and the microsystem's purpose on the other.
High-performing microsystems have a clearly stated purpose and mission. All too often, busy interdisciplinary lead improvement teams have not taken the time to discuss and agree on the purpose of the microsystem. Every member of the microsystem should have the opportunity to contribute to the purpose statement. This active discussion aims to connect individual members with the microsystem's purpose. It reveals each member's view of the microsystem purpose. Clarifying the purpose statement also establishes a guiding light for setting priorities and making decisions in the microsystem.
Individual members of the microsystem have knowledge about the patients they provide care and services to. This knowledge usually concerns individual patients or what happens on certain days of the week or during specific shifts. General population knowledge and general facts about the microsystem are not usually shared by all members of the microsystem. Gaining deeper knowledge about the patients and subpopulations of patients that the microsystem serves can enrich all members' decision making and their design of care and services. This knowledge can help microsystem members become better informed about how to take good care of patients and how to improve their delivery system.
Every member of the clinical microsystem who provides and contributes to the care of patients should be thought of as a professional. If every person, in every role, is respected for what he or she contributes to the smooth functioning of the microsystem, then individual self-esteem, morale, and engagement all rise. Charles Mayo, one of the Mayo Clinic's founders, reminds us, "There are no inferior jobs in any organization. No matter what the assigned task, if it is done well and with dignity, it contributes to the function of everything around it and should be valued accordingly by all" (Mayo, n.d.). Learning more about all the microsystem's professionals and what they do, what hours they work, what they wish to learn, and how they rate their workplace increases awareness for future improvement.
The interdisciplinary members of a microsystem participate in various processes, systems, and steps to care for patients. Their tasks are interrelated and should complement one another. Often microsystem members have never taken the time to meet to review specific processes of care that are repeated regularly in the system. The different views and perspectives of each member are revealed when the lead improvement team is asked to create a flowchart to show how routine care is delivered or how a patient enters the microsystem. This lack of knowledge about how the current process actually works and how it varies underlies and contributes to much of the waste and poor reliability within a microsystem. Identifying core processes and engaging all members in flowcharting the current state is a way to begin to design more efficient and effective processes. It gives the microsystem members insight about the contributions that each person makes to the process (see Figure A.11, in the Appendix). This often works best when one or two members construct the initial flow diagram and then others are asked to improve upon this draft. Eventually, the flowchart can be posted for all to review and edit.
Observing and measuring cycle times in processes of care can also help a microsystem group identify waste in daily work. Viewing the process of care through "the eyes of the patient" (see Figure A.5, in the Appendix) is a powerful tool for gaining important insight into that process from the patient perspective.
Patterns exist in every microsystem but often go unnoticed, unacknowledged, or unleveraged. Does everyone in your microsystem meet regularly to discuss what patients want and need or to talk about care or the microsystem's quality, cost, and safety outcomes? Who talks to whom? Who never talks to whom? What are the metrics that matter for the microsystem (see Figure A.14 in the Appendix and Godfrey et al., 2005c, p. 22)? Do all members know about, review, and discuss these metrics and causal systems? What has the microsystem improved, and what makes the members most proud? What does the microsystem celebrate? All of these patterns and more can be acknowledged and taken into consideration when increasing member's awareness about a microsystem and when taking action to improve that microsystem.
After making a plan and beginning to obtain the data and information, the lead improvement team is ready to review the microsystem's current state. Collecting a sample of information about each of the 5 P's is a good way to begin.
It requires that you identify the sources for the data. (The materials in the Appendix of this book can facilitate the collection, display, and assessment of the information about each of the 5 P's.) The resulting characterization of the system's current state can be very helpful as the microsystem members continue to gain deeper knowledge about its work.
A helpful five-step exercise follows. Remember, this exercise is best done by your interdisciplinary lead improvement team. It can be done in multiple sessions, to give the team time to review and discuss and to determine next steps and gain more information. For example, you could plan five sequential meetings, with a focus on one P at each meeting. Useful materials are (1) a microsystem wall poster, (2) five envelopes, each with preliminary information for one of the P's, and (3) tape. Here's how it works:
1. Assign a meeting leader, facilitator, timekeeper, and recorder prior to starting. Develop an agenda and timeline to cover all five steps in this exercise. Be sure to assign enough time for the team to cover each of the exercise steps. Plan enough time at the end of all the sessions to synthesize the information and prepare a report.
2. Prepare five envelopes that contain preliminary information from your microsystem about the 5 P's (purpose, patients, professionals, processes, patterns), one P per envelope. Some important information will be available and some will not. Use the workbook in the Appendix and the Web site to help you identify the data needed to assess and diagnose your microsystem. Focus on one P at a time. It is important to review the data, determine what additional information is needed and where it may be obtained, and then move to the next P.
3. Use the microsystem workbook to determine which tools will help the lead improvement team to gain deeper insight into the microsystem. Some of the needed microsystem information is in each of the envelopes that you prepared; the microsystem workbook can help you to assess and diagnose your microsystem, and it provides additional tools for collecting desired information.
4. When reviewing each P, some of the questions that follow this exercise may facilitate the team discussion.
5. At the end of the 5 P's series the lead improvement team will have a deeper awareness of its microsystem and can report back to all the microsystem members and summarize the learning and conclusions. The lead improvement team will also know what additional information it needs to deepen its own knowledge about its microsystem.
Review the following discussion questions when performing each section of this exercise:
1. Purpose a. What do you think about your organization's mission statement and the microsystem's mission statement?
b. How are these two statements aligned with each other?
c. How could your microsystem's purpose statement be improved?
2. Patients, professionals, processes, patterns a. What do you see after reviewing the information?
b. What other information do you need, and how can you obtain it?
c. Can you begin to make any initial assessments?
d. How can the microsystem workbook help you with the assessment?
3. Prepare a report on your findings (in the form of wall poster) for all the members of your microsystem.
a. Post graphical displays and tables under each of the 5 P's on the microsystem wall poster, displaying the information for all staff to review.
b. Make intentional plans for team members to identify microsystem members to review the microsystem wall poster findings, to increase awareness and to stimulate further discussions.
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