One lens missing? Clarifying the clinical microsystem framework with learning theories

The clinical microsystem (CMS) approach is widely used and is perceived as helpful in practice but, we ask the question: "Is its learning potential sufficiently utilized?"

To scrutinize aspects of learning within the CMS framework and to clarify the learning aspects the framework includes and thereby support the framework with the enhanced learning perspective that becomes visible.

Literature on the CMS framework was systematically searched and selected using inclusion criteria. An analytical tool was constructed in the form of a theoretical lens that was used to clarify learning aspects that are associated with the framework.

The analysis revealed 3 learning aspects: (1) The CMS framework describes individual and social learning but not how to adapt learning strategies for purposes of change. (2) The metaphorical language of how to reach a holistic health care system for each patient has developed over time but can still be improved by naming social interactions to transcend organizational boundaries. (3) Power structures are recognized but not as a characteristic that restricts learning due to asymmetric communication.

The "lens" perspective reveals new meanings to learning that enhance our understanding of health care as a social system and provides new practical learning strategies.