Table 1.

Five steps of the clinical microsystems approach

Step	Key activities
Step 1: Organise a ‘lead team’	Assemble a ‘lead team’ to represent all disciplines and roles in the practice (professional and clerical), and patients. Employ effective meeting skills, including assigning individual roles/tasks. Meets weekly to maintain focus, plan and oversee improvement work
Step 2: Do the 5Ps assessment	Complete the ‘5Ps’ assessment of Purpose, Patients, Professionals, Processes and Patterns using practice data and the microsystems workbook with templates. For example, fishbone diagram (cause and effect analysis) and data wall (metrics related to problem being addressed). Aims to create an overview of the system under review and identify improvement opportunities
Step 3: Make a diagnosis	Review the data (including strengths and weaknesses of the system) and select an issue to address. Create an overall theme, or global aim statement to maintain motivation and focus
Step 4: Treat the microsystem	This begins with making a specific aim statement using numerical goals, specific dates and specific measures. Uses Plan-Do-Study-Act (PDSA) as the model for improvement. Address sustainability issues using Standardize-Do-Study-Act (SDSA). Daily huddle whereby the team reviews the coming day/week to plan actions based on patient need and available resources, and contingency planning
Step 5: Follow-up	Monitor the new patterns of results and select new themes for improvement. Embed new habits into daily work using daily huddles, weekly lead team meetings, monthly all team meetings, data walls and storyboards

Source from Godfrey et al. 2010.