Table 1

 Characteristics of high performing microsystems

(1) LeadershipThe 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.
(2) Organizational supportThe larger organization looks for ways to support the work of the microsystem and coordinate the hand-offs between microsystems.
(3) Staff focusThere 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.
(4) Education and trainingAll clinical microsystems have responsibility for the ongoing education and training of staff and for aligning daily work roles with training competencies. Academic clinical microsystems have the additional responsibility of training students.
(5) InterdependenceThe interaction of staff is characterized by trust, collaboration, willingness to help each other, appreciation of complementary roles, respect, and recognition that all contribute individually to a shared purpose.
(6) Patient focusThe 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.
(7) Community and market focusThe 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.
(8) Performance resultsPerformance focuses on patient outcomes, avoidable costs, streamlining delivery, using data feedback, promoting positive competition, and frank discussions about performance.
(9) Process improvementAn atmosphere for learning and redesign is supported by the continuous monitoring of care, use of benchmarking, frequent tests of change, and a staff that has been empowered to innovate.
(10) Information and information technologyInformation 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.