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Kvalitetsdag 2009, Center for Kvalitet Workshop
Kliniske Mikrosystemer
Hvad skal der til for at DDKM kan blive et
nyttigt middel i kvalitetsudviklingsarbejdet for
frontlinje personalet i de kliniske afdelinger?
Kjeld Møller Pedersen Syddansk Universitet kmp_at_sam
.sdu.dk
2
SVAR At arbejdet med kvalitet gribes rigtigt
an!

1. organisering og ledelse
2. incitamenter
3. værktøjer
4. forankring/ansvar

Det drejer sig bare om at skabe en veldreven
afdeling/afsnit
DDKM er kun en skal - den lokale måde at
udfylde skallen på bliver afgørende
3
Patientoplevet
Faglig
Kvalitet
MEN savner en helhedsorienteret forståelsesramme
Organisatorisk
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Tilløb til en ramme hos Donabedian
Illustration af Donabedians kvalitetsmodel
Struktur Proces I
Proces II Resultat/outcome
Ressourcer og organisering
Aktiviteter
Ydelser
Effekt - I forhold til målgruppen

• bygninger/
• indretning
• apparatur/
• forskrifter
• personale
• (autorisation)
• intern organisering

• (god) praksis
• faglige
• (ideal) krav
• arbejdsrutiner
• referenceprogram-
• mer
• interne instrukser
• (manualer m.m.)

• funktionelt helbred
• morbiditet/mortalitet
• genoperationer/ligge-
• sår m.m., dvs. side-
• effekter
• patienttilfredshed

• operationer
• metode m.m.
• medicinering
• pleje-indsats
• osv..

MEN hvor er forhold som organisation og ledelse?
5
MEN et klinisk mikrosystem er en del af et
større system, fx. et hospital, det
primære sundhedsvæsen OG der er
(normalt) gensidig afhængighed

• Kliniske Microsystem
• afsnit
• afdeling
• lægepraksis
• osv..
• FRONTLINJE

hvor det giver mening at se det som et
(delvist) selvfungerende element
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Generel (og lidt abstrakt) definition
A clinical microsystem is a small group of
people who work together on a regular basis to
provide care to discrete subpopulations of
patients. It has clinical and business aims,
linked processes, and a shared information
environment, and it produces performance
outcomes. Microsystems evolve over time and are
often embedded in larger organizations. They are
complex adaptive systems, and as such they must
do the primary work associated with core aims,
meet the needs of internal staff, and maintain
themselves over time as clinical units.
To bring about fundamental change in the health
system of the magnitude required, there will need
to be systematic transformation at all levels of
the system. there have been very few efforts to
understand and change the front-line clinical
units that actually deliver the care. To move
toward a perfected system of care, the
performance of each individual microsystem must
be optimized and the linkages between different
clinical microsystems must be seamless, timely,
efficient, and thoroughly reliable . the
powerful new idea here is that the microsystem
concept offers an opportunity to transform health
care at the front line of service delivery.
7
Joint Commission Journal on Quality and Safety,
2002, 28(9) 472-93
Modellen/tænkemåden var baseret på undersøgelse
af 20 high performing mikrosystemer
Hospitaler, lægepraksis, plejehjem. high
performing omfattede alle tre dimensioner
af kvalitet, incl. produktivitet og effektivitet
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Kendetegn ved de 20 high performing microsystems
No single feature or success characteristic can
stand alone to produce high-quality, high-value
systemic results. That being said, a common set
of nine success characteristics were shared by
these microsystems and interact with one another
to produce highly favorable systemic outcomes
Leadership of microsystem Culture of
microsystem Macro-organizational support of
microsystem Patient focus Staff focus
Interdependence of care team Information and
information technology Process improvement
and Performance pattern.
der findes en artikel om hvert af emnerne
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(No Transcript)
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De 5 Per
To achieve the best possible outcomes for patients
Accessing systems and needs, diagnosing problems,
creating treatment plans and following up. The
results of these interactions produce patterns.
Patterns measure safety, functional status, risk,
patient satisfaction and cost outcomes. Patterns
of leadership, meetings to discuss care delivery,
cultural and traditional patterns and symbols,
values of the microsystem. As a whole they gauge
the value of care
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Bruger relevante tilrådighed-værende værktøjer

• Flow charts af forløb
• kritisk sti-analyse
• Fiskeben
• Gennembrudsmetoden
• PDSA
• Lean-metoder
• de 5 Ser
• Kerneårsagsanalyse
• osv..

vigtigt ikke at låse sig fast på
bestemte værktøjer/metoder Må afhænge
af problemets karakter
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(for) lang konsultationstid
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SPC statistical process control
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hvem tænkte balance scorecard?
15
Waste and the 5 Ss Waste is anything other than
the minimum amount of equipment, materials,
space and workers time which are essential to
add value to the product of service. Waste is a
symptom, not a cause, of a problem.
16
(No Transcript)
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SVAR At arbejdet med kvalitet gribes rigtigt
an!

1. organisering og ledelse
2. incitamenter
3. værktøjer
4. forankring/ansvar

Det drejer sig bare om at skabe en veldreven
afdeling/afsnit
DDKM er kun en skal - den lokale måde at
udfylde skallen på bliver afgørende