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The micropractice approach is based on the business
concept of "microsystems" popularized by Quinn and
applied to medical practices by Batalden et al. This
empiric work posits that the most successful models
of business and health care occur in the "smallest
replicable unit" of any organization. An SRU has: i)
a group of people working together to serve a
defined population of patient/customers, ii)
information flow between and among all of them for
the benefit of the patient/customer iii) relentless
application of improvement and waste reduction
methodologies to enhance reliability and
replication.
Stripped of the jargon, SRU applies in any
organization of any size. In solo practice,
the SRU is easy to define. In larger practices or
groups or organizations, the potential SRU sometimes
has to be discovered. The advantage, if any, of
using the "micropractice language" is to help
doctors confront the implications of the three
points listed above.
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Practices (potential SRUs) seldom understand
their population and how their team
functions...hence the baseline work. At
baseline we learn that most practices are
driven by "symptom management" such as
stress, "RVUitis" etc. without understanding
root causes such as overhead and highly
variable, ineffective, inefficient practice
patterns. Our goal is to guide discovery of
these root causes.
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At baseline the data systems are found not
to be information systems. The data systems
merely push around data for administrative
purposes or clinical data for very narrow
purposes. At best, patient-based
information is used to slightly modify the
current way of doing business. Hence folding
HYH, Vital Signs into everyday work as a
method to inject some real patient-centered
information...not just some more data.
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Everyone now knows "PDSA" (plan do study
act) but generally use it to focus on slight
modifications of the current way of doing
business. Or they use the chronic care model
and PDSA to come up with grand schemes for
"system redesign" that seldom reach nascent
SRUs. The lack of effect is predictable.
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What happens when you use the information from A
and B above to make your SRU really an SRU? This is
where we do the real work and it is still work in
progress. In summary, IMP work is not just
about small practices and small overhead. But it is
about small manageable change that builds up to
large replicable changes.
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