Kosnik Linda K, Espinosa James A
Overlook Hospital/Atlantic Health System, Summit, New Jersey, USA.
Jt Comm J Qual Saf. 2003 Sep;29(9):452-9. doi: 10.1016/s1549-3741(03)29054-7.
The microsystem, as agent for change, plays a critical and essential role in developing and deploying the macrosystem's strategic plan.
To effectively deploy a strategic plan, the organization must align the plan's goals and objectives across all levels and to all functional units. The concepts of microsystem thinking were the foundation for the journey on which Overlook Hospital/Atlantic Health System (Summit, NJ) embarked in 1996. Six stages can be identified in the development of the relationship between macrosystems and microsystems. Five critical themes--trust making, mitigation of constraints and barriers among departments and units, creation of a common vocabulary, raising of microsystem awareness, and facilitation of reciprocal relationships--are associated with these stages.
The emergency department (ED) experienced Stage 1--The Emergence of a Self-Aware Microsystem--as it created cultural and behavioral change, which included the actualization of staff-generated ideas and an ongoing theme of trust making. In Stage 3--Unlike Microsystems (Different Units) Learn to Collaborate--the ED's microsystems approach spread to other units in the hospital. Collaboratives addressed x-ray turnaround times, admission cycle times, and safety initiatives.
The microsystem--the small, functional, front-line units--is where the strategic plans become operationalized.
微系统作为变革的推动者，在制定和实施宏观系统的战略计划中发挥着关键且重要的作用。
为有效实施战略计划，组织必须使计划的目标在各级和所有职能部门保持一致。微系统思维的概念是奥弗布鲁克医院/大西洋医疗系统（新泽西州萨米特）于1996年踏上征程的基础。在宏观系统与微系统关系的发展过程中可识别出六个阶段。五个关键主题——建立信任、减少部门和单位间的限制与障碍、创建通用词汇、提高微系统意识以及促进相互关系——与这些阶段相关联。
急诊科经历了第一阶段——自我意识微系统的出现——在此过程中它实现了文化和行为变革，包括员工想法的落实以及持续的建立信任主题。在第三阶段——不同微系统（不同单位）学会协作——急诊科的微系统方法传播到了医院的其他单位。协作解决了X光检查周转时间、入院周期时间以及安全举措等问题。
微系统——小型的、功能性的一线单位——是战略计划得以实施的地方。
