Health System Levels
A paradigm shift is underway in healthcare, from a volume-based system to the current value-based system, and the abounding uncertainty and tumultuous changes that are ensuing are a sign of this shift (Khan et al., 2018; Marchildon & Fletcher, 2016). Thomas Kuhn’s (1970) theory of paradigm shifts suggests that such shifts in paradigms create opportunity. At present, the healthcare arena is chaotic, with some stakeholders holding onto the old system while others are forging ahead with change. In the midst of the disorder opportunity awaits for healthcare reform. The AACN Essentials (2006) identify the DNP scholar as a leader poised to respond to the complexity and chaos across the health system. As a DNP-prepared nurse, you will use your expertise in translating evidence to improve outcomes in multiple settings across the health system.
In structure, the health system is composed of a several components: front-line clinical microsystems, in-between mesosystems, overarching macrosystems, and patients needing care. Macrosystems are part of the megasystem of American healthcare, which itself is a component of the even larger economic, political, and social metasystems of society as a whole and, ultimately, a part of global systems. Let’s explore the role of the DNP scholar across these systems.
The microsystem setting is the point of care. For many, the microsystem is the most familiar aspect of the health system in which patients, staff, information, and equipment converge for the purpose of providing care. It is the place where patients, families, and care teams meet. Clinical microsystems do the everyday hands-on work within an organization, and vary in terms of quality, safety outcomes, and cost performance (Nelson et al., 2002). Examples of microsystems include but are not limited to a nurse-midwifery practice, a renal dialysis team, a fertility clinic, a cardiac surgery team, an emergency department, or an inpatient maternity unit.
The mesosystem is the middle level that interfaces between the microsystem and the macrosystem. The mesosystem replaces patient-centeredness with patron-centeredness. It is the management level of a health system, which links microsystems together to allow them to move from separate units to those that support patients along their continuum of care (Litosky, 2014).
The macrosystems are larger health systems that are composed of smaller systems. Macrosystems contain meso- and microsystems; therefore, the outcomes of the macrosystem are never greater than the outcomes of the microsystems of which it is composed (Nelson et al., 2002). It is the widest lens through which to consider a healthcare problem. Examples of macrosystems include but are not limited to as a chief operating officer, board of directors, or a professional organization.
At each level of a health care system, DNP-prepared scholars can take decisive action to improve quality outcomes. A health system that is patient-centered, high-quality, safe, and efficient cannot occur without the transformation of the individual levels that combine to form the care continuum.
View the activity below to explore the Micro, Meso, and Macrosystems Practice Setting as it relates to the practice scholar.
We have learned the value of studying and changing the microsystems of healthcare—the people, equipment, and data at the level of direct patient care. The levels of healthcare systems focus on the microsystem (patient point of care), mesosystem (provider), or macrosystem (policy and/or regulatory) levels. The practice change projects you’ll be working on in the future will be set in one of these levels of the healthcare system. The approach you take to the healthcare issues will evolve over time. Importantly, don’t forget to take a glimpse at these problems from a helicopter view!