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Microsystems in health care: Part 3. Planning patient-centered services. 2003

Marjorie M Godfrey, and Eugene C Nelson, and John H Wasson, and Julie J Mohr, and Paul B Batalden
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

BACKGROUND Strategic focus on the clinical microsystems--the small, functional, frontline units that provide most health care to most people--is essential to designing the most efficient, population-based services. The starting place for designing or redesigning of clinical microsystems is to evaluate the four P's: the patient subpopulations that are served by the microsystem, the people who work together in the microsystem, the processes the microsystem uses to provide services, and the patterns that characterize the microsystem's functioning. DIAGNOSING AND TREATING A CLINICAL MICROSYSTEM: Methods and tools have been developed for microsystem leaders and staff to use to evaluate the four P's--to assess their microsystem and design tests of change for improvement and innovation. Based on its assessment--or diagnosis--a microsystem can help itself improve the things that need to be done better. Planning services is designed to decrease unnecessary variation, facilitate informed decision making, promote efficiency by continuously removing waste and rework, create processes and systems that support staff, and design smooth, effective, and safe patient care services that lead to measurably improved patient outcomes. CONCLUSIONS The design of services leads to critical analysis of the resources needed for the right person to deliver the right care, in the right way, at the right time.

UI MeSH Term Description Entries
D007857 Leadership The function of directing or controlling the actions or attitudes of an individual or group with more or less willing acquiescence of the followers. Influentials
D008281 Maine A state bounded on the east by the Atlantic Ocean, on the north by Canada, and on the south and west by New Hampshire.
D009817 Office Management Planning, organizing, and administering activities in an office. Management, Office
D010347 Patient Care Planning Usually a written medical and nursing care program designed for a particular patient. Nursing Care Plans,Goals of Care,Plans, Nursing Care,Care Goal,Care Goals,Care Plan, Nursing,Care Planning, Patient,Care Plans, Nursing,Nursing Care Plan,Plan, Nursing Care,Planning, Patient Care
D010934 Planning Techniques Procedures, strategies, and theories of planning. Planning Theories,Methodology, Planning,Planning Methodology,Planning Technic,Planning Methodologies,Planning Technics,Planning Technique,Planning Theory,Technic, Planning,Technique, Planning,Theory, Planning
D011320 Primary Health Care Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192) Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D006301 Health Services Needs and Demand Health services required by a population or community as well as the health services that the population or community is able and willing to pay for. Health Services Needs,Needs,Needs and Demand, Health Services,Target Population,Health Services Need,Need, Health Services,Needs, Health Services,Population, Target,Populations, Target,Target Populations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014600 Utilization Review An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use. Review, Utilization,Reviews, Utilization,Utilization Reviews
D017064 Process Assessment, Health Care An evaluation procedure that focuses on how care is delivered, based on the premise that there are standards of performance for activities undertaken in delivering patient care, in which the specific actions taken, events occurring, and human interactions are compared with accepted standards. Process Assessment (Health Care),Assessment, Process,Process Measures,Assessment, Process (Health Care),Assessments, Process,Assessments, Process (Health Care),Measure, Process,Measures, Process,Process Assessment,Process Assessments,Process Assessments (Health Care),Process Measure

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