Table 2.
Clinical microsystems success characteristics and representative verbatim quotes
| Success characteristic13 15 | Representative quote |
| 1. Leadership: the role of leaders is to balance setting and reaching collective goals, and to empower individual autonomy and accountability, through building knowledge, respectful action, reviewing and reflecting. | “I think, my gut feeling is vision. They’ve always cared about the quality of service. They’ve always wanted to do better. They’ve always wanted to improve. They’ve always wanted to explore and see what else is out there and how we can do things differently”. (PM, RRMA 5) |
| 2. Organisational support: the larger organisation looks for ways to support the work of the microsystem and coordinate the hand-offs between microsystems. | “I think, primarily, being involved with the APCC (Australian Primary Care Collaboratives). …Well that’s my impression, because I’ve been involved with it heavily. I think it allowed us to develop the systems you’ve touched on to make things a little more streamlined, a little more efficient… to improve patient care…” (GP, RRMA 4) |
| 3. Staff focus: there is selective hiring of the right kind of people. The orientation process is designed to fully integrate new staff into culture and work roles. Expectations of staff are high regarding performance, continuing education, professional growth and networking. | “You can create a nice environment, nice place … but unless you’ve got the right people, it doesn’t work, yeah”. (GP, RRMA 1) |
| 4. Education and training: all clinical microsystems have responsibility for the ongoing education and training of staff and for aligning roles with training competencies. Academic clinical microsystems have the additional responsibility of training students. | “Also it’s a teaching practice with medical students and nursing students. So, you are constantly teaching people, so you have to always be kind of like on top of best practice and what’s going on to facilitate that, I think”. (PN, RRMA 5) |
| 5. Interdependence: the interaction of staff is characterised by trust, collaboration, willingness to help each other, appreciation of complementary roles, respect and recognition that all contribute individually to a shared purpose. | “I think it’s the team effort… I think everybody’s got jobs and everybody does their jobs, but if you can’t do your own job and you ask for help, it’s given…It’s not just one person, and it’s not just one doctor, and it’s, it’s a whole group of us that want to see out the patient quality of care. And we’ve all got great ideas”. (PN, RRMA 1) |
| 6. Patient focus: the primary concern is to meet all patient needs—caring, listening, educating and responding to special requests, innovating to meet patient needs and smooth service flow. | “I think we’ve always looked at the patient as the whole patient rather than just a quick fix”. (PN, RRMA 4) |
| 7. Community and market focus: the microsystem is a resource for the community; the community is a resource to the microsystem; the microsystem establishes excellent and innovative relationships with the community. | “We have a good community sort of contact. We’re regularly involved in council sort of stuff. Yeah, we donate to council, we donate to the school, breakfast clubs and things like that… we’re pretty good with our community ties. I think that’s one thing that keeps us in good stead with everyone”. (GP, RRMA 4) |
| 8. Performance results: performance focuses on patient outcomes, avoidable costs, streamlining delivery, using data feedback, promoting positive competition and frank discussions about performance. | “We have targets that we all agree on. We get on well; so we talk, and if someone has a problem, we will talk about it usually with our colleagues. We’re comfortable to actually discuss our mistakes. I think it’s important”. (GP, RRMA 4) |
| 9. Process improvement: an atmosphere for learning and design is supported by the continuous monitoring of care, use of benchmarking, frequent tests of change and a staff that has been empowered to innovate. | “Every day there’s something that happens that we think, ‘how can we change that to make it better?’ …as recently as yesterday, you know; we’re always sort of constantly improving”. (PM, RRMA 4) |
| 10. Information and information technology: information is THE connector—staff to patients, staff to staff, needs with actions to meet needs. Technology facilitates effective communication and multiple formal and informal channels are used to keep everyone informed all the time, listen to everyone’s ideas and ensure that everyone is connected on important topics. | With patients: “We use patient-held records and I think that is really valuable. So it, the patient-held record is about the patients knowing what their results are, what their condition is, it’s about having education and it’s also about then having the ability to share the information with the appropriate people outside the practice”. (GP, RRMA 4) Providers and staff: “So, if we recruit new staff, especially GPs, they’re aware of what needs to go into data…. Because everything, all the information (is) in the notes, if someone’s not here, they can just pick it up and look at it and they know. So, they, those kinds of things flow on”. (PM, RRMA 1) Integration of information with technology: “I mean we still use the pen tool… it becomes habit it becomes policy, it just becomes part of the way that we practice… ah and I think now that people are actually starting to see the value of the quality of data”. (PM RRMA 1) |
*Pen Tool is an automated data aggregation program marketed by Pen Computing Systems and provided to GP clinics by mesolevel organisations such as Medicare Locals.
GP, general practitioner; PM, practice manager; PN, practice nurse; RRMA, Rural, Remote and Metropolitan Areas.