2013-03-01
Stakeholder Perspectives
Using a Microsystem Lens
Julie Johnson
Göran Henriks
28 February 2013
Session D1: 1330 – 1430
Our Agenda
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Introductions
Göran’s story – the problem with cancer
care
A microsystem approach for thinking
about the problem
Small group work to apply microsystem
concepts to cancer care
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2013-03-01
Göran’s Story
The
problem with cancer care
Study on the gaps between inpatient
and community microsystems
What
if we approached the interface as a
clinical microsystem with stakeholders defined
as patient, inpatient physician, inpatient
nurse, and GP?
Would we see the relationship between the
two settings differently?
Supported by a grant from the European Union,
the Framework Programme of the European Commission
(FP7-HEALTH-F2-2008-223409)
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Microsystem Concepts
Refresher #1
Success
Characteristics
Staff
Leadership
• Staff focus
• Education &
Training
• Interdependence
of care team
• Leadership
• Organizational
support
Information
&
Information
Technology
Performance
• Performance
results
• Process
improvement
Patients
• Patient Focus
• Community &
Market Focus
Microsystem Concepts
Refresher #2
Know Your Microsystem’s 5 Ps
Purpose
Patients
Professionals
Processes
Patterns
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Methods
Semi-structured individual interviews
28 key stakeholders from 2 hospitals in the
Netherlands
Asked about general handover communication
and perceptions on patient transitions
Organized data into seven ‘virtual’ clinical
microsystems, each composed of:
one patient
hospital-based physician
hospital-based nurse
community-based general practitioner
For example . . .
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A second example . . .
Findings
Healthcare providers do their best but . . .
Providers often work in isolation, not taking advantage of
the “virtual microsystem” that exists between the
inpatient and community care settings
Five themes related to effective/ineffective care
Exchange of adequate information to care for patient
Provider’s availability and opportunity for personal
contact
Protocols to guide the transition
Feedback about the transition
Appropriate us of IT to facilitate communication
Role and responsibility of the patient in own care
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Small Group Exercise
Form
Patient’s individual preferences
a small group of 4 people
Choose one role for each person in your group
(patient, hospital physician, nurse, GP)
Develop a list of ideas and principles to improve
care for the problem that Göran presented for
cancer patients
Prepare to report back
Patient’s process
Patient’s context Patientens sammanhang
First symtom Patienten’s context
Första symtom
Patientens sammanhang
First contakt
Första kontakt
Patienters
individuella
preferenser
Undersökning
bedömning
uppföljning
Information
Behandling/
åtgärd
Kompetens
Symtom
Patient
Patient
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2013-03-01
Approach and findings
Actions of improvement concepts showing
the quality and safety, and a multidimensional
measures of results:
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Family members participating
Early detection
Quick exam
Patient`s process map
Perioperative work
Schedule the whole
individual process at once
• ERAS (Enhanced
Recovery After Surgery)
”Patient
partnership”
Debriefing
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