clinical microsystems – an organisational development approach to service improvement laura hibbs...
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Clinical Microsystems – an Clinical Microsystems – an organisational development organisational development
approach to service improvementapproach to service improvement
Laura HibbsLaura HibbsService Improvement Manager, NEYNL SHAService Improvement Manager, NEYNL SHA
Diane RothwellDiane RothwellProject Manager, NEYNL CHD CollaborativeProject Manager, NEYNL CHD Collaborative
www.clinicalmicrosystem.orgwww.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?
A frontline team of patients, clinicians, A frontline team of patients, clinicians, managers, admin and information staff managers, admin and information staff working together in an information rich working together in an information rich environment to deliver and improve environment to deliver and improve services to a defined population of patientsservices to a defined population of patients
What is a clinical microsystem?What is a clinical microsystem?
What is a clinical microsystem?What is a clinical microsystem?
Community, Market,
Social Policy System
Macro-organization
System
Clinical Microsystem
Individual care-giver & patient System
Self-care
System
For example…For example…
……Echocardiography in Barnsley.Echocardiography in Barnsley.
Patients
Nurses
DoctorsInformationsystem (old)
Informationsystem (new)
Receptionist
Secretaryand
AdministratorTechnicians
HealthCare
Assistant
DoctorDoctor
ReceptionistReceptionist
TechnicianTechnician
Information system (modern)Information system (modern)
Health Care AssistantHealth Care Assistant
Information system (traditional)Information system (traditional)
NursesNurses
Secretary and AdministratorSecretary and Administrator
PatientsPatients
MicrosystemsMicrosystems are theare the building blocksbuilding blocks that come that come together to form together to form larger organisationslarger organisations
What is the Microsystems Model?What is the Microsystems Model?
The Microsystems ModelThree key components
The Microsystems ModelThree key components
• The 4 P’s Framework
• Tools and techniques
• Teamwork
• The 4 P’s Framework
• Tools and techniques
• Teamwork
PatientsWho are they? What do we need to know about them?
Processes How do we run the things? What are our systems?
Patterns How do things vary? What causes variation?
Peoplethe employees; How to involve them more? What do staff think?
PP
……aiming to build a aiming to build a comprehensivecomprehensive understanding of the understanding of the microsystem and how it works.microsystem and how it works.
PP PP PP
The 4 PsThe 4 Ps
WorkforceDevelopment
Small groups
Task Force
Team
Crew
PLAN
PLAN
DODO
STUDY
STUDY
ACTACT
PDSA cycles
Flow charts &deployment
charts
FishbonediagramsMeeting
skills & disciplines
Variable
0
5
10
15
20
25
30
35
40
Date
Ou
nce
s
Run charts &control charts
Global AimTemplate
Data & measures
Generativerelationships
F
£
C S
Clinical value compass
Basecamp: “What do I get” (1,2)Basecamp: “What do I get” (1,2)
Camp 1: “What do I give? (3,4,5,6) Camp 1: “What do I give? (3,4,5,6)
Camp 2: “Do I belong here?” (7,8,9,10) Camp 2: “Do I belong here?” (7,8,9,10)
Camp 3: “How can we all grow?” (11, 12) Camp 3: “How can we all grow?” (11, 12)
SummitSummit
Data wallsData walls(Swedish style)(Swedish style)
Data wallsData walls(…and in the boardroom)(…and in the boardroom)
• Introduction and survey materialsIntroduction and survey materials• Colour coded for the 4 PsColour coded for the 4 Ps• ‘‘Starter pack’ for microsystem workingStarter pack’ for microsystem working• Materials developed by UK pilot sitesMaterials developed by UK pilot sites• Adaptation and improvement continues!Adaptation and improvement continues!• Materials available as MS Word Materials available as MS Word
documents to change and adaptdocuments to change and adapt
Microsystems resource packMicrosystems resource pack
“How to use…”- Four headings:
“How to use…”- Four headings:
How to use the Patient Viewpoint Survey What is it?
A short yet comprehensive self-completion questionnaire to gauge overall patient satisfaction with the service provided by the microsystem. Why use it?
Regular surveys of patient satisfaction are a vital tool to assess how well the microsystem is meeting the needs of its patients. This survey asks both specific questions about the process and experience of care, as well as open questions asking for ideas, views and comments in the patient’s own words. The survey format follows the process of care, starting with access and appointment making and moving on to the quality of their encounter with staff. The ‘multiple choice’ questions 1 to 9 can be scored to give an overall ‘satisfaction’ rating which can be plotted over time to assess the impact of changes within the microsystem on over patient experience. Because the survey, whilst anonymous, asks the patient to specify their age and sex, analysis of differencing experiences of men and women, and the elderly versus the young, can be undertaken. How to use it
The survey can be distributed to a sample of patients, or to all patients attending on particular days or at particular times. Patients should be reassured that their responses will be anonymous, and that they will be greatly assisting the microsystem by giving their views on their experience of care. Make sure that patients have the necessary time, space and equipment (pen, pencil etc.) to be able to complete the questionnaire comfortably. Anonymity can be reinforced by providing a box to put the questionnaires in on completion, rather than handing them to a staff member. Some organisations distribute self-addressed envelopes to enable the questionnaire to be posted back if enough time or space is not available for completion at the premises. Once sufficient numbers of questionnaires have been returned, collate the results and graph the responses to questions 1 to 12. Collate the answers to the write-in questions and present them as a list of quotes. If large numbers of questionnaires have been received, categorise the written comments by themes and provide appropriate examples. Display the results in the microsystem, and use them to promote discussion in staff meetings. Suggestions for improvement are obviously useful when considering changes to the microsystem. Also, the ‘surprises’ encountered by patients can be a useful way to assess what expectations patients may have had, and how they have been met. Notes and tips
It is arguable that there is an inherent bias toward positive reporting of satisfaction in this sort of survey. Bearing this in mind, the pattern of scores should be considered so that items reporting lower levels of satisfaction relative to the other questions should be viewed as worthy of further investigation and possible improvement.
• What is it?• What is it?
• Why use it?• Why use it?
• How to use it?• How to use it?
• Notes and tips• Notes and tips
• Team approachTeam approachShared vision, mission, informationShared vision, mission, informationAgreed priorities, improvement plansAgreed priorities, improvement plansRegular meetings, learning eventsRegular meetings, learning eventsRegularly review and improve team climateRegularly review and improve team climate
• Learn simple improvement toolsLearn simple improvement toolsKaizen approach, PDSA cyclesKaizen approach, PDSA cyclesImprovement tools/techniquesImprovement tools/techniques
• Review, reflect and plan togetherReview, reflect and plan togetherHow are we doing? Where next?How are we doing? Where next?
TeamworkTeamwork
Cardiology DepartmentBarnsley District General Hospital
Cardiology DepartmentBlackburn Royal Infirmary
Clinical Measurement DepartmentSouthern Derbyshire Acute Hospitals
Ilkeston Community HospitalErewash PCT
Neurological Outpatient DepartmentHurstwood Park Hospital
Foxhall Day Surgery UnitIpswich Hospital
Cardiac Monitoring UnitHull Royal Infirmary
Riverside SurgeryNorth Lincolnshire PCT
How can it support you in your improvement work?How can it support you in your improvement work?
Wasting time in IpswichWasting time in Ipswich
Evaluating microsystems in the NHS…some early comments from sites:
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
• 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
• 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
• 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
Evaluating microsystems in the NHS…some early comments from sites:
Evaluating microsystems in the NHS…some early comments from sites:
• Involves everyone (Involves everyone (…the whole team, not just a …the whole team, not just a ‘select few’‘select few’))
• Comprehensive and flexible (Comprehensive and flexible (…not ‘problem …not ‘problem focussed’ or highly prescribedfocussed’ or highly prescribed))
• Values staff views, experiences and welfare equally Values staff views, experiences and welfare equally ((…avoids improvement at staff expense…avoids improvement at staff expense))
• Draws together different strands of improvement Draws together different strands of improvement work (work (e.g. access improvement and workforce e.g. access improvement and workforce developmentdevelopment))
• Builds on any previous improvement projects (Builds on any previous improvement projects (……provides somewhere to go after project endsprovides somewhere to go after project ends))
Microsystem working…Microsystem working…
Any Questions?
Key Contacts
Ian Golton, Modernisation Agency
Peter Wilcock, NHSU [email protected]
Laura Hibbs, NEYNL SHA
[email protected] 07879 898152
Diane Rothwell, NEYNL CHD Collaborative
[email protected] 01482 335802
www.clinicalmicrosystem.org