Microsystems in health care: Part 7. The microsystem as a platform for merging strategic planning and operations.

BACKGROUND The microsystem, as agent for change, plays a critical and essential role in developing and deploying the macrosystem's strategic plan. STRATEGIC PLANNING AND MICROSYSTEM THINKING To effectively deploy a strategic plan, the organization must align the plan's goals and objectives across all levels and to all functional units. The concepts of microsystem thinking were the foundation for the journey on which Overlook Hospital/Atlantic Health System (Summit, NJ) embarked in 1996. Six stages can be identified in the development of the relationship between macrosystems and microsystems. Five critical themes--trust making, mitigation of constraints and barriers among departments and units, creation of a common vocabulary, raising of microsystem awareness, and facilitation of reciprocal relationships--are associated with these stages. NOTES FROM A MICROSYSTEM JOURNEY The emergency department (ED) experienced Stage 1--The Emergence of a Self-Aware Microsystem--as it created cultural and behavioral change, which included the actualization of staff-generated ideas and an ongoing theme of trust making. In Stage 3--Unlike Microsystems (Different Units) Learn to Collaborate--the ED's microsystems approach spread to other units in the hospital. Collaboratives addressed x-ray turnaround times, admission cycle times, and safety initiatives. SUMMARY AND CONCLUSIONS The microsystem--the small, functional, front-line units--is where the strategic plans become operationalized.