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Effecting Change in Your Clinical Microsystem

Do we possess the power to effect change in the current claims and litigation climate? YES, indeed.

Without minimizing the importance of efforts in the regulatory and legislative arena, every obstetrical nurse, midwife, and physician can exert power to reduce the number of problem cases that enter the claims/litigation pipeline. There is early evidence that reducing the number of claims and lawsuits can show a positive effect on availability and cost of professional liability insurance in some states.

PRIOR to an adverse event, the average timeline is hours or days.

Who controls the process?

  • Patient
  • Family members
  • Nurses, midwives, physicians

AFTER an adverse event, the timeline can span years.

Who controls the process?

  • Patient
  • Family members
  • Risk managers
  • Claims managers
  • Plaintiffs' attorneys
  • Defense attorneys
  • Expert witnesses
  • Judges
  • Juries
  • Licensing boards
  • Credentialing bodies
  • Nurses, midwives, physicians

Your clinical 'microsystem'

The U.S. does not have an organized health care system.

A clinical microsystem is the place where patients, families, and care teams meet. It is front-line care, and it includes the support staff, processes, technology, and recurring patterns of information and behavior and results. The patient is central to every clinical microsystem. A clinical microsystem approach to improving health care requires the involvement and investment of all frontline players, including patients and families. It requires observation, data collection, intervention, measurement, and analysis.

It takes about 18-24 months to become a high-performing microsystem. The focus is on the patient and not on a particular skill and how to sell it.

The greatest power for change lies on the front lines, where patients AND caregivers meet.

Paul Batalden MD
The Dartmouth Institute
Toolkit available online at Clinical Microsystems 

For more information on Dartmouth-Hitchcock's Obstetric Safety Initiative, or to offer suggestions or additions to this site, contact us.

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