• Microsystems
• continuous quality improvement

The fox knows many things, but the hedgehog knows one big thing.—Archilochus

Isaiah Berlin, in one of his most famous essays, quotes Greek poet Archilochus' line fragment about the fox and a hedgehog as a metaphor for the chasm between those who relate everything to a single vision which is driven by a central organising principle and those who pursue multiple, sometimes contradictory, strategies to achieve a goal.1 Simply put, the hedgehog has one strategy. The fox has many. While Berlin points out that the distinction may be a somewhat artificial oversimplification—imagine trying to classify all philosophers, writers, CEOs, clinical leaders, etc into one category or the other—the comparison offers a point of view which can be a starting-point for genuine investigation.

The use of the clinical microsystem as an organising framework for the delivery and improvement of healthcare often reminds me of that metaphor along with a more common one, ‘If all you have is a hammer everything looks like a nail.’ This somewhat colloquial saying which refers to an over-reliance on a familiar tool has also been called the law of the instrument,2 attributed both to Abraham Maslow3 and to Abraham Kaplan.4 It's a familiar feeling—adopting a tool or method …