About Us

The Dartmouth Institute Microsystem Academy is a leader in Clinical Microsystem development, research, teaching, and coaching since this work began in the early 1990s. Through the integration of professional experience, empirical and cutting-edge research methodologies and information, the Microsystem Academy’s education programs offer exciting and rigorous action learning curricula in the art and science of healthcare quality improvement.


To provide vital education and coaching tools and resources to support exceptional health care and the continual improvement of care across the globe.


To develop high-performing systems of care based on a clinical microsystems approach and team coaching methodology, through:

  • Developing strategic relationships with interdisciplinary health care providers and patients and their families; 
  • Offering the knowledge, processes, and tools to support the development of organizational improvement capability; 
  • Conducting action research that explores microsystems, mesosystems and macrosystem organization, leadership development, and team coaching; and,
  • Learning by doing and acting on evaluative information to improve our methods and the programs and services we offer.


We are strongly committed to:

Advancing the field of continual improvement at all levels of health care delivery systems

Collaborating with health systems to co-design and improve population health

Honoring the unique contexts and needs of clients and strategic partners

Disseminating new knowledge widely so that others may easily benefit

What is a Microsystem?

A Small Group

A clinical microsystem is a small group of people who work together on a regular basis to provide care to discrete subpopulations of patients.

An Evolving System

A clinical microsystem evolves over time and is often embedded in larger organizations.

An Adaptive System

A clinical microsystem is a complex adaptive system, and as such it must do the primary work associated with core aims, meet the needs of its members, and maintain itself over time as a clinical unit (Value by Design, pp. 3–4).

Performance Outcomes

A clinical microsystem has clinical and business aims, linked processes, and a shared information environment, and it produces performance outcomes.

It’s Transformative

Value creation at the overall health system level depends not only on the improvement and innovation that takes place within microsystems, but in the integration between and across the many frontline functional units that make up the system. Two or more microsystems create a mesosystem, which reflects the journey of the patient and family. In fact, transformation of these essential building blocks that combine to form the care continuum is critical to realizing the value proposition of a seamless, patient-centered, high quality, safe, and efficient health system.

Organizations that have intentionally developed pervasive improvement capability in their microsystems have a strategic advantage when it comes to accelerating and sustaining system- level improvement. These organizations have an efficient and effective means of getting everyone involved to accomplish their strategic plan campaign.”

Nolan, Value by Design