Clinical microsystems, Part 4. Building innovative population-specific mesosystems

Jt Comm J Qual Patient Saf. 2008 Nov;34(11):655-63. doi: 10.1016/s1553-7250(08)34083-5.


Background: In 2005, the Geisinger Health System (Danville, Pennsylvania) developed ProvenCare, first applied to coronary artery bypass graft (CABG), as an innovative provider-driven quality improvement program to promote reliable delivery of evidence-based best practices. A new mesosystem is created for each ProvenCare model, integrating the care delivery process between contributing microsystems and defining new mesosystem leadership. The approach has been expanded to many patient populations, including percutaneous coronary intervention (PCI).

A new pci mesosystem: In 2007 clinical microsystem thinking was applied to PCI: understanding the current processes and patterns, assembling the frontline professionals to redesign the processes, and using a beta-test phase to measure the changes and adjust accordingly, until the best process was established. A new mesosystem team was created to ensure that the right care is delivered at the tight time.

Refining implementation: In the course of developing the CABG initiative, Geisinger established role definitions to keep teams on track; a comprehensive plan from design through execution and follow-up; and guiding principles established for the teams engaged in designing, developing, and implementing ProvenCare programs.

Preliminary experience: For the 40 measurable process elements in the PCI mesosystem pathway, as of month seven (July 2008) of the beta-test phase, 55% of the patients received 100% of the identified process elements.

Conclusion: Geisinger Health System has joined different microsystems to form an innovative mesosystem capable of producing reliable, evidence-based care for patient subpopulations. This approach to embedding evidence-based care into routine care delivery can be adapted by others.

MeSH terms

  • Cooperative Behavior*
  • Coronary Artery Bypass
  • Diffusion of Innovation
  • Humans
  • Interdepartmental Relations
  • Models, Organizational*
  • Organizational Case Studies
  • Pennsylvania
  • Quality Assurance, Health Care / organization & administration*