title: Microsystems in health care: Part 8. Developing people and improving work life: what front-line staff told us.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Huber
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Godfrey
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Nelson
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Mohr
authors.forename: Christine
authors.initials: C
authors.lastname: Campbell
authors.forename: Paul B
authors.initials: PB
authors.lastname: Batalden
mesh_terms: D001900:Boston; D003142:Communication; D006801:Humans; D007400:Interprofessional Relations; D009013:Morale; D009042:Motivation; D019982:Organizational Case Studies; D009936:Organizational Innovation; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D010557:Personnel Administration, Hospital / Q000379:methods / Q000592:standards*; D011369:Professional-Patient Relations; D011788:Quality of Life; D013192:Staff Development; D014481:United States; D000078329:Workforce; D017132:Workplace / Q000523:psychology