The path to sustainability in health care: Exploring the role of learning microsystems

• Purpose – This chapter examines the developmental journey toward a sustainable health care system in the West of Skaraborg County in Sweden from 2008 to the present by proposing and illustrating the concept of a clinical microsystem to capture the work of a mobile team to care for elderly people with multiple diseases in its embedded context. Design – An action research approach was adopted that entailed four researchers, one of whom was also a health care practitioner, engaging in iterative dialogues with the mobile team. This aimed at catalyzing joint learning in repeated action-reflection cycles at least three times a year over a period of 3 years. Data from patient databases were also drawn upon as additional resources for reflection. Findings – The outcome of the initial periods of the team’s work in the microsystem dramatically improved the care of these patients, significantly increasing quality of life and stabilizing their medical situation. It has also led to decreased resource utilization, not just by the team, but elsewhere in the wider health system. Originality/value – We draw on and develop the concept of clinical microsystems to argue that such systems have a team at their core, but their work practices and patient outcomes require us to look beyond the team itself and take into account its interactions with patients and actors in the wider health care system. We also draw on the framework of Christensen, Grossman, and Hwang (2009) to propose that each microsystem has three distinct value configurations, namely shops, a chain, and a network. In terms of design, we suggest that the clinical microsystem can be seen as a parallel learning structure to that of the established health care bureaucracy.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Omvårdnad (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nursing (hsv//eng)

SAMHÄLLSVETENSKAP  -- Medie- och kommunikationsvetenskap -- Systemvetenskap, informationssystem och informatik med samhällsvetenskaplig inriktning (hsv//swe)

SOCIAL SCIENCES  -- Media and Communications -- Information Systems, Social aspects (hsv//eng)

Nyckelord

Learning

Sustainable health care system

Sustainable effectiveness

Clinical microsystems

Teams

Sustainability

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