Dod Patient Safety Program - Clinical Microsystems
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Clinical Microsystems Description The Clinical Microsystem Framework is an approach to improving healthcare quality and safety designed specifically for busy frontline staff. The framework utilizes systems thinking, creating knowledge of how care is delivered. It provides staff with a straightforward improvement process uncomplicated by jargon and statistical requirements. This Framework increases frontline staff’s ability to identify problems, detail care processes, formulate and measure improvement plans while fostering open communication, transparency and a commitment to improvement. The Clinical Microsystem Framework creates a culture change that enhances safety and patient centered care where improvement is part of the daily work activities.
Requirements for getting started The Clinical Microsystem Framework focuses on the small (micro)systems of care within any Military Treatment Facility (MTF). These are the departments, units, programs or clinics that are composed of a group of people who work together as a team to provide care to a subpopulation of patients; possess a clinical and business aim, linked processes, and a shared information environment all of which influence performance and clinical outcomes. The decision to embark upon the Clinical Microsystem process for improvement may be based upon a curiosity, a requirement, an event, or other need. Facilities that seek to engage in the Clinical Microsystem process must obtain the support of their Commanding Officer and notify their respective Service’s Patient Safety Chief followed by contacting the DoD Center for Education & Research in Patient Safety (CERPS). What Leadership Should Know
The Commanding Officer should be informed that the Clinical Mircosystem Framework is a systems approach to improvement and one of many available methods for improving care. The difference between this framework and other approaches is: • Focused on frontline staff for a bottomup approach to improvement • The process is simple and allows for immediate improvements • Creates an environment and culture focused on improvement and understanding the processes that supports Six Sigma, Lean and AFSO 21 • Requires the appropriate team composition including physicians • Requires time be allocated to meet and make improvements • Leadership participation, a willingness to meet with the team monthly
The Process Activity Milestones Team Identification
Pre-Work
On-Site
Follow-Up
1-2 Weeks
6-8 Weeks
3 Days
3-18 Months
Commander Officer’s Invitation A letter of invitation from the Commanding Officer requesting CERPS support and indicating support for the effort, will initiate the program planning process. Team Composition Once the commitment has been made, a team must be identified. The composition of the team must represent everyone who works within the microsystem; including physicians, nurses, technicians, administrative staff, civilian, military, foreign nationals. Success is dependent upon the full representation and commitment of the staff that works within the specific program or microsystem. Once the team has identified the following information should be sent to CERPS:
• • •
Team composition Email address and phone numbers of team members Point of Contact for all communication
Prework The prework is designed to guide the team to a better understanding of how they provide care. It is vitally important that they complete the pre work as the Clinical Microsystem builds upon the knowledge generated by the prework. Teams should view the prework as a data collection effort, where they are collecting data on aspects of their care delivery system. Some of the data will be readily available through multiple sources and other data will have to be collected. The team should meet regularly to discuss the prework requirements and data collection approach. The time required to complete the pre work is between 68 weeks. The prework packages have been tailored to reflect inpatient and outpatient environments. Understand that the prework has been developed to meet the generic environment and that modification of the data elements to a specific microsystem is appropriate. CERPS will schedule a phone call 3 weeks into the prework process to discuss any issues or questions the team may have regarding the pre work. Please note that the final product of the prework should be a 10 minute team briefing that will be given on the first day of the onsite visit to the Commanding Officer and Executive Staff. This briefing should highlight general information about the microsystem and any discovers made during the prework process. Onsite The onsite phase is a handson guided intervention to assist teams in the analysis of the prework data, delineation a care process and development of a plan for improvement. Requirements • Entire team must be available for the 3day onsite interaction from
•
• •
Team inbriefing and outbriefing with the Commanding Officer and Executive Staff o Inbrief – a synopsis of assessment and discoveries o Outbrief – a synopsis of analysis and plan for improvement Inbrief to be conducted at 1300 on the first day of the onsite Outbrief to be conducted at 1330 of the third day of the onsite
Followup The followup phase involves regular monthly phone calls with the CERPS team and monthly briefings. The phone calls with CERPS are designed guide the team forward. The teams will report on the activities of the past months and discuss any issues or barriers they are encountering. They will also report out the data and findings from their improvement activities. The regular monthly meetings with the Commanding Officer and/or Executive Staff are designed to provide the team with the opportunity to describe what they have accomplished and what serve as barriers to success. This briefing provides accountability and access for the team, and affords the Commanders the opportunity to interact and intercede when appropriate. Duration of the followup period is dependent upon the team and the Commanding Officer. Experience has shown that it takes 34 months for the team to see a measurable difference and 1218 months for the culture of a unit to change. Successful teams have worked with CERPS for a minimum of 12 months during the followup period.
Requirements for getting started The Clinical Microsystem Framework focuses on the small (micro)systems of care within any Military Treatment Facility (MTF). These are the departments, units, programs or clinics that are composed of a group of people who work together as a team to provide care to a subpopulation of patients; possess a clinical and business aim, linked processes, and a shared information environment all of which influence performance and clinical outcomes. The decision to embark upon the Clinical Microsystem process for improvement may be based upon a curiosity, a requirement, an event, or other need. Facilities that seek to engage in the Clinical Microsystem process must obtain the support of their Commanding Officer and notify their respective Service’s Patient Safety Chief followed by contacting the DoD Center for Education & Research in Patient Safety (CERPS). What Leadership Should Know
The Commanding Officer should be informed that the Clinical Mircosystem Framework is a systems approach to improvement and one of many available methods for improving care. The difference between this framework and other approaches is: • Focused on frontline staff for a bottomup approach to improvement • The process is simple and allows for immediate improvements • Creates an environment and culture focused on improvement and understanding the processes that supports Six Sigma, Lean and AFSO 21 • Requires the appropriate team composition including physicians • Requires time be allocated to meet and make improvements • Leadership participation, a willingness to meet with the team monthly
The Process Activity Milestones Team Identification
Pre-Work
On-Site
Follow-Up
1-2 Weeks
6-8 Weeks
3 Days
3-18 Months
Commander Officer’s Invitation A letter of invitation from the Commanding Officer requesting CERPS support and indicating support for the effort, will initiate the program planning process. Team Composition Once the commitment has been made, a team must be identified. The composition of the team must represent everyone who works within the microsystem; including physicians, nurses, technicians, administrative staff, civilian, military, foreign nationals. Success is dependent upon the full representation and commitment of the staff that works within the specific program or microsystem. Once the team has identified the following information should be sent to CERPS:
• • •
Team composition Email address and phone numbers of team members Point of Contact for all communication
Prework The prework is designed to guide the team to a better understanding of how they provide care. It is vitally important that they complete the pre work as the Clinical Microsystem builds upon the knowledge generated by the prework. Teams should view the prework as a data collection effort, where they are collecting data on aspects of their care delivery system. Some of the data will be readily available through multiple sources and other data will have to be collected. The team should meet regularly to discuss the prework requirements and data collection approach. The time required to complete the pre work is between 68 weeks. The prework packages have been tailored to reflect inpatient and outpatient environments. Understand that the prework has been developed to meet the generic environment and that modification of the data elements to a specific microsystem is appropriate. CERPS will schedule a phone call 3 weeks into the prework process to discuss any issues or questions the team may have regarding the pre work. Please note that the final product of the prework should be a 10 minute team briefing that will be given on the first day of the onsite visit to the Commanding Officer and Executive Staff. This briefing should highlight general information about the microsystem and any discovers made during the prework process. Onsite The onsite phase is a handson guided intervention to assist teams in the analysis of the prework data, delineation a care process and development of a plan for improvement. Requirements • Entire team must be available for the 3day onsite interaction from
•
• •
Team inbriefing and outbriefing with the Commanding Officer and Executive Staff o Inbrief – a synopsis of assessment and discoveries o Outbrief – a synopsis of analysis and plan for improvement Inbrief to be conducted at 1300 on the first day of the onsite Outbrief to be conducted at 1330 of the third day of the onsite
Followup The followup phase involves regular monthly phone calls with the CERPS team and monthly briefings. The phone calls with CERPS are designed guide the team forward. The teams will report on the activities of the past months and discuss any issues or barriers they are encountering. They will also report out the data and findings from their improvement activities. The regular monthly meetings with the Commanding Officer and/or Executive Staff are designed to provide the team with the opportunity to describe what they have accomplished and what serve as barriers to success. This briefing provides accountability and access for the team, and affords the Commanders the opportunity to interact and intercede when appropriate. Duration of the followup period is dependent upon the team and the Commanding Officer. Experience has shown that it takes 34 months for the team to see a measurable difference and 1218 months for the culture of a unit to change. Successful teams have worked with CERPS for a minimum of 12 months during the followup period.
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