Conclusion
Shared decision-making is an essential process that is often impeded by the complexity of our medical system. The proposed model serves to distill the complexity by forming a SDM microsystem around each patient. Such a microsystem would offer continuity by transcending changes in time, personnel and sites of care. The SDM microsystem for each patient could be formed and integrated into the work of acute care microsystems, such as the PICU, as needed. This staged, microsystem approach would allow for the flexibility needed to assemble the unique combination of people and information needed for each child, and would also provide enough structure to promote reproducibility and enable systematic evaluation of the process. Reproducibility and measurement will be essential for developing appropriate value-based payment systems for SDM. Prospective research studies would be needed to determine the feasibility of such an approach as well as to develop and evaluate measures of the quality of the SDM process. This conceptual model could be expanded to other medically complex populations of all ages for whom shared decision making is needed.