1. Sheffield Microsystem Coaching Academy
Open Meeting Slides

2. 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

3. 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)

4. 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

5. Introduction

6. Quality Improvement Microsystem Improvement

7. 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)

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

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

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

11. 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

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

13. “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

14. 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

15. ‘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

16. 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

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

18. 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)

19. 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)

20. 5 Ps Diagnosing the system We need data to understand the system
Purpose
Patterns
Patients
5 Ps
Processes
Professionals

21. 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
Form a lead improvement group

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