Microsystems for Patient Safety

Posted on July 12, 2012


This post will be the first of several about leadering microsystems and how this can lead to a resilient, high performing clinical area.

A microsystem is the smallest functioning unit of a system (Quinn as cited in Godfrey, Nelson, Wasson, Mohr, & Batalden, 2003). This theory applied to healthcare defines clinical microsystems as the foundations of healthcare. Clinical microsystems are:

In terms of systems theory, clinical microsystems evolve and are embedded in larger systems. According to Nelson, et al. (2002) these clinical microsystems are complex adaptive systems (CAS). CAS are described as types of systems that follow the tenets of complexity theory (Schneider & Somers, 2006). Complexity theory differs from open system theory in that open systems show more linear patterns, cycles and homeostasis while complexity theory shows
systems as functioning on the edge of chaos, emerging, and adapting to sometimes previously unknown conditions that can arise from the outside or emerge from the interactions within itself (Schneider & Somers, 2006). Chaotic systems have patterns but trajectory and path are not always predictable and being on the edge of chaos is needed for adaptability (Schneider & Somers, 2006). In complexity theory homeostasis is a killer and this seems to apply to healthcare as we will die in terms of achieving patient safety if we maintain the status quo rather than constantly push the edge of accomplishment. There will always be some unknown to deal with in healthcare whether it be disease related, environment related or system related. When we make changes, the outcome may be somewhat predictable but there may also be unintended side

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