The clinical microsystems approach: Does it really work? A systematic review of organizational theories of health care practices

Faced with increased expectations regarding the quality and safety of health care delivery systems, a number of stakeholders are increasingly looking for more efficient ways to deliver care. This study was conducted to provide a critical appraisal and synthesize the best available evidence on the impact of implementing clinical microsystems (CMS) on the quality of care and safety of the health care delivery. A comprehensive and systematic search of 6 electronic databases, from 1998 to 2018, was conducted to identify empirical literature published in both English and French, evaluating the impact of implementing CMS in health care settings. We included all study designs that evaluate the impact of implementing CMS in health care settings. Independent reviewers screened abstracts, read full texts, extracted data from the included studies, and appraised the methodological quality. Of the 1907 records retrieved, 35 studies met the inclusion criteria. The settings included general practice clinics (n = 18), specialized care units (n = 14), and emergency and ambulatory units (n = 3). The implementation of CMS helped to develop the patient-centered approach, promote interdisciplinarity and quality improvement skills, increase the fluidity of the clinical acts performed, and increase patient safety. It contributed to increasing patients’ and clinicians’ satisfaction, as well as reducing hospital length of stay and reducing hospital-acquired infections. The implementation of CMS also contributed to the development and refinement of diagnostic tools and measurement instruments. The CMS approach is unique because of the primacy given to the quality of care offered and the safety of patients over any other consideration, and its ability to redesign health care delivery systems. Efforts still need to be made to legitimize the approach in various health care settings worldwide.