Sheffield Microsystem Coaching Academy Open Meeting Slides

Aims & Objectives for today To commence quality improvement Give you an overview of microsystem improvement To begin thinking what we need to improve To define what will be our first steps

Agenda Aim, Agenda, Ground Rules (5 mins) Introduction (From the Leader) (5 mins) An introduction to Quality Improvement (Coach) (10 minutes) Your patients (Team) (30 minutes) Define the next steps (Coach/Team) (5 mins) Evaluation (5 mins)

Example Ground Rules It’s about the system not individuals All contributions are valuable Please don’t interrupt Don’t say it can’t be done! If you oppose you must propose Mobiles & Blackberry's off - or at least on silent Be present on time Cut off lengthy discussions – Park the ideas Assign meeting roles Have and follow an agenda Assign actions only to those present at the meeting

Introduction

Quality Improvement Microsystem Improvement

What is Quality? Care that is - Safe (Do No Harm, Safety for all patients, in all processes, all the time) Effective (Produces the desired result) Patient Centred (Seamless, with respect and compassion) Timely (With undue delay or waiting) Efficient (Done without waste - resources, time, people, done competently.) Equitable (Equity at the population level (across subgroups, locations) and at the individual level)

Improvement The combination of a ‘change’ (improvement) combined with a ‘method’ (an approach or specific tools) to attain a superior outcome

Source: Henriks, Bojestig, Jonkoping CC Sweden System Levels Example Frontline Patient Units Mesosystem Microsystem Macrosystem Directorate Hospital Source: Henriks, Bojestig, Jonkoping CC Sweden

Improving Microsystems – The Elements Team Coaching Improvement Science Microsystem QI Workbook p8 10

Based on experience, what is recommended for successful improvement work? 1. The need for structure – ‘the ramp’, weekly meetings 2. A coach to support you, but ownership from the team 3. Must have senior management support – enabling time and space for improvement work to happen 4. Involve patients from the start 5. Start small and build confidence 6. Use measurement to show changes are improvements 7. Share your data

Microsystem Improvement - The structure SDSA ‘Standardise’ Treatment - PDSA Diagnose - Change Ideas Assessment - 5Ps Effective Meetings

“Every system is perfectly designed to get the results it gets.” System Redesign “Every system is perfectly designed to get the results it gets.” Paul B. Batalden, MD Co-Founder The Institute for Healthcare Improvement Founding Director, Center for Leadership and Improvement, The Dartmouth Institute for Health Policy and Clinical Practice Founding Director, Healthcare Improvement Leadership Development Co-Founder Institute for Healthcare Improvement The outcomes is based on 13

Involving the front line ‘If you want to make true and lasting change, ask the people who do the work how to go about it’ Daren Anderson, MD VP/Chief Quality Officer Community Health Center, Inc. 14

‘Improvement in health care is 20% technical and 80% human’ People and behaviours ‘Improvement in health care is 20% technical and 80% human’ Marjorie Godfrey, MS, RN The Dartmouth Institute for Health Policy and Clinical Practice 15

To do things differently, we must see things differently To do things differently, we must see things differently. When we see things we haven’t noticed before, we can ask questions we didn't know to ask before. John Kelsch, Xerox www.clinicalmicrosystem.org

The 5Ps - Assessing the system Purpose Patterns Patients 5 Ps Processes Professionals

Assessment Lets start with your patients Can you define a typical patient? (5 mins) Can you define what they want and need from the service? (5 mins) Present back (5 mins)

Assessment – Love & Nuts 1 Thing that … Patients really love about our service is (5 mins) makes some patients nuts about our service (5 mins) Present back (5 mins)

5 Ps Diagnosing the system We need data to understand the system Purpose Patterns Patients 5 Ps Processes Professionals

Next Steps – the 5Ps sign up to get involved! Staff survey Patient survey Organise a Patient representative? What are the core processes – Process mapping Cycle times – how long do things take? What is the patient flow? Who is involved – who are the stakeholders within and beyond the department, what do they do? Background 5Ps data More information on the 5Ps at www.sheffieldmca.org.uk Form a lead improvement group

Evaluation 10 What went well? What could be improved? Next Meeting -