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Clinical Microsysytems in the Emergency Department

Authors: Lisa Anne Toland , Breda Naddy, Philip Crowley

Abstract Introduction: Clinical Microsysytems is an improvement approach which was originally introduced in Ireland in 2013/2014 in Emergency Departments. A microsysyems facilitator was appointed in September 2016 jointly with the Quality Improvement Division, HSE and the Emergency Medicine Programme to re-invigorate the work, to re-engage staff and to escalate the learning.This type of approach promotes healthcare workers, patients and their families working together to improve care.Practice Change: A collaberative approach was set up for frontline staff in Emergency Departments(ED) in one hospital group initially. The reason for commencing with only one hospital group was to have a small group of staff members from the multi-discliplinary team across ED’s who had asked for support with Microsysytems. These were identified following a number of site visits to hospitals with previous experience with this type of improvement work.Aim: The aim at the outset was to re-engage staff in Microsystems improvement at the frontline, to develop a network for staff involved , to train new staff members with an interest in Quality Improvement and to spread the learning.Targeted population and stakeholders: The first collaberative was to focus on frontline staff in Emergency Departments as this is where the original training had taken place. The senior management in each hospital were approached to ensure they were fully informed of the support and to seek their endorsement and full support for the staff involved. This was noted as a key component following the site visits by the facilitator . The senior quality leads for the hospital group were also contacted and other relevant key personnel within the HSE to ensure support for this work was sought form the outset.Timeline: The initial collaberative was planned to take place over a six month period with a combination of training days, webinars and the establishment of a support network for staff to allow them to share ideas and experiencesHighlights: Sustainability.The facilitator and a Qualitative researcher carried out a number of focus groups prior to the first training day with staff with previous experience of Microsystems. The aim was to explore the barriers and facilitators to sustaining this type of work. The findings were analysed and shared with the collaberative participants and the key findings were taken into consideration for the training days and shared as learning across the Quality Improvement Division.Transferability. As this is the first collaberative the learning will be tranferable for future groups not only in the Emergency Department setting but to other microsytems in healthcare. Each multi-discliplinary team was asked from the outset to consider improvement projects which would link microsystem units within their organisation.Conclusions: Clinical Microsysytems is an adaptable improvement approach which can be used across heathcare settings and promotes healthcare workers, patients and their families working together to improve care. Frontline staff can not do this work alone , they need a combination of support both from within their units, and within their organistaion and also from external sources.


clinical, microsystems, multi-disciplinary, staff engagement

How to Cite:

Toland LA, Naddy B, Crowley P. Clinical Microsysytems in the Emergency Department. International Journal of Integrated Care. 2017;17(5):A547.

DOI: on 17th October 2017