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Understanding the complexity of redesigning care around the clinical microsystem
  1. P Barach1,
  2. J K Johnson2
  1. 1Department of Anesthesia, University of Miami, Miami, FL, USA
  2. 2Department of Medicine, University of Chicago and American Board of Medical Specialties, Evanston, IL, USA
  1. Correspondence to:
 Dr P Barach
 Department of Anesthesia, University of Miami, 1611 NW 12th Avenue, Miami, FL 33136, USA; pbarach{at}


The microsystem is an organizing design construct in which social systems cut across traditional discipline boundaries. Because of its interdisciplinary focus, the clinical microsystem provides a conceptual and practical framework for simplifying complex organizations that deliver care. It also provides an important opportunity for organizational learning. Process mapping and microworld simulation may be especially useful for redesigning care around the microsystem concept. Process mapping, in which the core processes of the microsystem are delineated and assessed from the perspective of how the individual interacts with the system, is an important element of the continuous learning cycle of the microsystem and the healthcare organization. Microworld simulations are interactive computer based models that can be used as an experimental platform to test basic questions about decision making misperceptions, cause-effect inferences, and learning within the clinical microsystem. Together these tools offer the user and organization the ability to understand the complexity of healthcare systems and to facilitate the redesign of optimal outcomes.

  • design
  • clinical microsystems
  • patient safety
  • process mapping
  • organizational learning

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  • This work was partially supported by a grant from the American Heart Association, Award Number 0330274N.

  • Competing interests: none.

  • Full Ethics Committee/IRB approval was secured for this study at the Universities of Chicago and Miami.