Microsystems in health care: Part 8. Developing people and improving work life: what front-line staff told us

Jt Comm J Qual Saf. 2003 Oct;29(10):512-22. doi: 10.1016/s1549-3741(03)29061-4.


Background: The articles in the Microsystems in Health Care series have focused on the success characteristics of high-performing clinical microsystems. Realization is growing about the importance of attracting, selecting, developing, and engaging staff. By optimizing the work of all staff members and by promoting a culture where everyone matters, the microsystem can attain levels of performance not previously experienced.

Case study: At Massachusetts General Hospital Downtown Associates (Boston), a primary care practice, the human resource processes are specified and predictable, from a candidate's initial contact through each staff member's orientation, performance management, and professional development. Early on, the new employee receives materials about the practice, including a practice overview, his or her typical responsibilities, the performance evaluation program, and continuous quality improvement. Ongoing training and education are supported with skill labs, special education nights, and cross-training. The performance evaluation program, used to evaluate the performance of all employees, is completed during the 90-day orientation and training, quarterly for one year, and annually.

Conclusion: Some health care settings enjoy high morale, high quality, and high productivity, but all too often this is not the case. The case study offers an example of a microsystem that has motivated its staff and created a positive and dynamic workplace.

MeSH terms

  • Boston
  • Communication
  • Humans
  • Interprofessional Relations
  • Morale
  • Motivation
  • Organizational Case Studies
  • Organizational Innovation
  • Outpatient Clinics, Hospital / organization & administration*
  • Patient-Centered Care / organization & administration*
  • Personnel Administration, Hospital / methods
  • Personnel Administration, Hospital / standards*
  • Professional-Patient Relations
  • Quality of Life
  • Staff Development
  • United States
  • Workforce
  • Workplace / psychology