Group Micro Analysis

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Group Micro Analysis

• Karen M. Findley RN, BSN, Vanessa
  Jackson-Flanagan RN, BSN Elizabeth Larsen RN,
  BSN, Shelly Logan RN, BSN

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• Please email questions to jstanley_at_aacn.nche.edu

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Background

• In summer quarter 2006 we each performed a micro
  analysis of our respective units
• As CNL students we found this useful laying the
  foundation in defining the role for our unit

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Institute of Medicine (IOM) Report

• The micro analysis was based on a technical
  report by the Institute of Medicine (IOM)
  Committee on the Quality of Health Care in
  America entitled, Exploring Innovation and
  Quality Improvement in Health Care Micro-
  Systems A Cross-Case Analysis (2001)

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Details

• Purpose - Examine a micro system so that
  meaningful inferences can be made about it
• Definition of micro analysis - A small, organized
  patient care unit with a specific clinical
  purpose, set of patients, technologies, and
  practitioners who work directly with these
  patients
• Process
• Analyze the unit on 14 variables in the report
• 8 of these variables are ranked on a spectrum
  from low to high
• It is expected that each micro system will vary
  from high to low

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Investment in Improvement

• An effort to ensure that improvement is part of
  the micro system
• Determined if time and money are provided for
  advancing degree, CEUs, obtaining
  certifications,
• Determined advancement opportunities for nurses
  such as clinical ladders
• Evaluated how accessible information was for
  staff

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Alignment of Roles and Training

• The match between a health professionals
  educational training, certification, etc. and
  their work
• Obtained job description
• Evaluated unit skill mix
• Observed staff performance
• Interviewed unit staff for degree status and
  years of experience
• Organizational unit support for further education
  and career development

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Constancy of Purpose

• Integration of aim through out the micro system
• Inquired about a mission statement for the unit
• Determined the cohort(s) of patients in the micro
  system

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Values

• A set of beliefs that guide the work of the micro
  system
• Determined the values, goals, and mission
  statements for the micro and macro systems
• Underlying values or aims such as caring for a
  particular population

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Organizational Support

• Ways the macro system facilitates work of the
  micro system
• Asked the staff at the micro level if they feel
  the support at the macro level
• Assessed if the aim and purpose is constant at
  the micro and macro levels

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Interdependence of the Care Team

• The existence and recognition of the team
  approach to care
• We determined who the leader or leadership team
  was for each unit
• We observed interdisciplinary rounds
• Assessed the communication styles of the care
  team

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Connection to the Community

• Micro system is a resource to the
  community/community is a resource to the micro
  system
• Determined the various types of facilities the
  micro system works with (community nursing homes,
  hospice, home care, etc)
• Inquired about community events such as health
  fairs and community education initiated at the
  unit level

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Micro System Measures

• Variables high performing micro systems are
  monitoring
• We determined which indicators were measured at
  the micro system level (length of stay,
  medication errors, fall rates, readmission rates,
  patient satisfaction)

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Use of Information and Technology

• Information is key, technology can be very
  helpful
• We assessed if the facility had a computerized
  patient record
• Determined if the system was home grown or
  purchased from the company
• The capabilities the system allows (medication
  administration, documentation, orders, lab tests,
  etc.)

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Barriers

• Challenges and constraints to the work of the
  micro system
• Assessed each micro system for specific issues or
  concerns that impede the micro system
  (communication, staffing, etc.)

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Resources for Replication

• Necessary elements to design and implement a
  similar micro system
• Determined the amount of staff needed to set up a
  similar micro system
• Considered equipment and supplies necessary
• Considered the environment (wide doorways, walls
  supplied with oxygen and room air)

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Evidence of the Micro System

• An indication that the site is a micro system
• Considered the definition of micro system and
  determined that our units were micro systems

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Improvement Example

• Examples of improvement projects made within the
  micro system
• Nursing leadership role redesign - CNL
• Patient satisfaction initiatives
• Development of mentor programs

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Leadership

• Importance of leadership to the work of the micro
  system
• Evaluated the leader or leadership teams on the
  unit
• Assessed how well they work together to drive the
  work of the micro system

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Benefits

• Identify areas of success as well as areas that
  need improvement
• Identify barriers so you formulate a performance
  improvement plan
• Network with unit staff and organizational
  management
• Get an outsiders perspective
• For those already working in the micro system,
  you are able to glean a new perspective

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Reference

• Institute of Medicine. (2001). Exploring
  Innovation and Quality Improvement in Health Care
  Micro-Systems A Cross-Case Analysis.
  Washington, DC National Academies Press.

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Questions?

• Please email them to jstanley_at_aacn.nche.edu