Proposition Purposeful health systems regularly examine their environments internally and externally to locate important trends and forces in the present and future that will impact their performance goals and mission efforts. These health systems understand who their stakeholders are, their needs, and how best to meet those expectations and needs. These systems pay attention to specific efforts to achieve goals that generate opportunities throughout the environment while continuing to adjust their internal structures and functions. Specific goals are addressed through uninterrupted sequences for performance improvement. The strategic directions of the systems come from the mission and directives. Strategic directions are identified by observing key stakeholders, responding to their interests, and being proactive in responding to current and future changes and trends throughout the systems environment (Skinner, 2001). The goal of this article is to understand how microsystems can affect macrosystems and vice versa when attempting to accomplish strategic direction within health systems, how microsystems help realize a system's vision health care and realize this vision, how performance measures at both levels are used when considering strategic dynamics, and how health care systems can begin to change inefficiencies to become more effective at both levels. This paper will discuss in more detail: For strategic dynamics to be successful at both levels, each level must begin to understand why things are done a certain way and how they work. impacts others within their system; Organizations need motivators to improve the strategic direction of the system; and Performance towards Strategy...... middle of paper ...... ling blocks for action. (2002). [PDF document]. Retrieved from http://www.who.int/chp/knowledge/publications/icccglobalreport.pdf?ua=1Kosnik, LK and Espinosa, JA (2003). Microsystems in healthcare: part 7. The microsystem as a platform for merging strategic planning and operations. From the Joint Commission Journal on Quality and Patient Safety, Volume 29, Number 9, pp. 452-459. Nerenz, DR and Neil, N. (2001). Health system performance measures. Article commissioned for the Health Management Research Center. [PDF document]. Retrieved from Systemswww.hret.org/chmr/resources/cp19b.pdfOrganization and service delivery. (2011). Retrieved from http://web.worldbank.org/wbsite/external/topics/exthealhnutritionandpopulation/exthsd/0Skinner, HA (2001). Promoting health through organizational change. San Francisco: Benjamin Cummings.