Clinical Microsystems – an organisational development approach to service improvement Laura Hibbs Service Improvement Manager, NEYNL SHA Diane Rothwell Project Manager, NEYNL CHD Collaborative www.clinicalmicrosystem.org

Aims What is a clinical microsystem? What is the microsystems model and how can it support you in your improvement work? What can we learn from the experience of two of the national pilot sites?

What is a clinical microsystem? A frontline team of patients, clinicians, managers, admin and information staff working together in an information rich environment to deliver and improve services to a defined population of patients

What is a clinical microsystem? Community, Market, Social Policy System Self-care System Macro-organization System Individual care-giver & patient System Clinical Microsystem

…Echocardiography in Barnsley. For example… …Echocardiography in Barnsley.

 Secretary and Administrator Nurses Technicians Patients Information system (new) Health Care Assistant  Receptionist Information system (old) Doctors

Information system (modern) Receptionist Patients Nurses Information system (traditional) Secretary and Administrator Health Care Assistant Technician Doctor

Microsystems are the building blocks that come together to form larger organisations

What is the Microsystems Model?

The Microsystems Model Three key components The 4 P’s Framework Tools and techniques Teamwork

The 4 Ps P P P P Patients Who are they? What do we need to know about them? People the employees; How to involve them more? What do staff think? Processes How do we run the things? What are our systems? Patterns How do things vary? What causes variation? …aiming to build a comprehensive understanding of the microsystem and how it works.

Clinical value compass PLAN DO STUDY ACT PDSA cycles Variable 5 10 15 20 25 30 35 40 Date Ounces Run charts & control charts Generative relationships Flow charts & deployment charts Data & measures Workforce Development F £ C S Clinical value compass Global Aim Template Small groups Task Force Team Crew   Fishbone diagrams Meeting skills & disciplines

Summit Camp 3: “How can we all grow?” (11, 12) Camp 2: “Do I belong here?” (7,8,9,10) Camp 1: “What do I give? (3,4,5,6) Basecamp: “What do I get” (1,2)

Data walls (Swedish style)

(…and in the boardroom) Data walls (…and in the boardroom)

Microsystems resource pack Introduction and survey materials Colour coded for the 4 Ps ‘Starter pack’ for microsystem working Materials developed by UK pilot sites Adaptation and improvement continues! Materials available as MS Word documents to change and adapt

“How to use…” - Four headings: What is it? “How to use…” - Four headings: Why use it? How to use it? Notes and tips

Teamwork Team approach Shared vision, mission, information Agreed priorities, improvement plans Regular meetings, learning events Regularly review and improve team climate Learn simple improvement tools Kaizen approach, PDSA cycles Improvement tools/techniques Review, reflect and plan together How are we doing? Where next?

How can it support you in your improvement work? Cardiology Department Barnsley District General Hospital Blackburn Royal Infirmary Clinical Measurement Department Southern Derbyshire Acute Hospitals Ilkeston Community Hospital Erewash PCT Neurological Outpatient Department Hurstwood Park Hospital Foxhall Day Surgery Unit Ipswich Hospital Cardiac Monitoring Unit Hull Royal Infirmary Riverside Surgery North Lincolnshire PCT How can it support you in your improvement work?

Wasting time in Ipswich

Evaluating microsystems in the NHS …some early comments from sites: Liked the ability to adapt materials (e.g. tailor questionnaires) to differing settings Have been selective in which surveys and questionnaires have been used Gone at their own pace Have variably used the 'tools’ - different bits found to be useful at different sites Focus on staff views and issues has been popular

Evaluating microsystems in the NHS …some early comments from sites: Took a while to get to grips with what microsystems working was and how to apply Lot of things (too much?) fitted into the sessions Pace of work - monthly sessions - has been ‘challenging’. Prompt or pressure? Have used it to build on previous work Hearing about each others’ experiences had been possibly the most useful aspect

Microsystem working… Involves everyone (…the whole team, not just a ‘select few’) Comprehensive and flexible (…not ‘problem focussed’ or highly prescribed) Values staff views, experiences and welfare equally (…avoids improvement at staff expense) Draws together different strands of improvement work (e.g. access improvement and workforce development) Builds on any previous improvement projects (…provides somewhere to go after project ends)

Any Questions?

Key Contacts www.clinicalmicrosystem.org Ian Golton, Modernisation Agency Ian.golton@npat.nhs.uk Peter Wilcock, NHSU peter.wilcock@nhsu.org.uk Laura Hibbs, NEYNL SHA Laura.hibbs@neynlha.nhs.uk 07879 898152 Diane Rothwell, NEYNL CHD Collaborative Diane.Rothwell@herhis.nhs.uk 01482 335802 www.clinicalmicrosystem.org