Table 1 Challenges on Medical Services by Microsystem Domain

Local Leadership

• Nursing and physician leaders often operate in silos.

• Physician leadership at the unit level may not exist.

• Formal training of unit leaders is often lacking.

Focus on Needs of Staff

• Dispersion of physicians limits their connection to any particular unit.

• Team members inconsistently given orientation to units/services.

• Team member roles and expectations not defined.

Emphasis on Needs of Patients

• Patients have poor comprehension of plan of care.

• Limited opportunities exist for patients and families to partner in care.

Attention to Performance

• Performance data often unavailable at the unit level.

• Limited data to prompt changes during patients’ hospitalizations.

Rich Information Environment

• Few opportunities for team members to share information and collaborate on better decisions.

• Technology not leveraged to identify opportunities to improve care.