Where Do Clinical Microsystems Fit in the Health Care Delivery System

It is the nature of systems to contain systems and to be embedded inside systems. The living cell is a system, and together with other cells it forms organs, and organs form the human body, and humans form families, and families form communities— all systems. Figure 11.3 shows how it is possible to view the health care system as a set of concentric circles, with smaller systems embedded in larger systems.

The individual patient's self-care system is the innermost system. The patient is literally at the center of the health care system. The next system level is the patient and individual caregiver. The microsystem is next, with the patient, family,


Geopolitical, market system



physicians, nurses, technicians, nurse practitioners, physician assistants, nursing assistants, and other professionals working with the patient. The microsystem is nested within the mesosystem of health care, which often takes the form of service lines (such as cardiac care) or departments (such as surgery or nursing). All of this fits within the larger organization, or macrosystem. The outer layer of these embedded health systems consists of the environment—the community, health care market, and health policy and regulatory milieu. This general structure—of small health systems embedded in larger health systems—applies to most health care systems in the developed world.

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