sheffield microsystem coaching academy · coaching workshop - 24 may 2017 agenda . time topic led...

Sheffield Microsystem Coaching Academy

Coaching Workshop

24 May 2017

9.00 – 16.20

Room 2, R Floor, RHH

9.15 – 9.30 Jim

Welcome Agenda

Aim of the coaches workshop

An opportunity for coaches to re-engage

with coaching, refresh and practice tools

and skills, including data and measurement

Great discussions with

other coaches and some

really good interactive

sessions

Really enjoyed

catching up and

discussing issues

with fellow coaches

and trainers.

Coaching Workshop - 24 May 2017

Agenda

. Time Topic Led By Room

9:00 Registration & refreshments Room 2

9.15 Welcome, agenda Jim Room 2

9.30 Excel basics - This session teaches some basic Excel skills including data displays and formulas

Rachael &

Aileen 4a

Patient co-production & experience care mapping – Are we listening to patients? Using FFT data Nick & Laura Room 2

10.30 Coffee Room 2

10.45 Excel pivot tables

An opportunity to have a go at creating pivot tables and manipulating them Garry 4a

A coaching story – 5p’s to PDSA Mark Room 2

11.45 Coaches support meeting (Troika)

An opportunity for coaches to use this model to get a different perspective on their coaching issues Nick Room 2

12.45 Lunch Room 2

13.15 Improvement bazaar – an informal poster session All Room 1

Posters from FLOW, Project Management Office, Hillsborough Nurses Project, SHSC, SCH, Weston

Park, Patient Activation Measure, Coaches Survey, Seamless Surgery, Outstanding Outpatients,

Elective Team

Presenters at

posters Room 1

14.00 Manipulating dates and times in Excel – This session will give you tips on how to do this Garry 4a

What do you measure - A common roadblock is helping teams to measure their changes. This

practical session helps identify practical measures; tips and techniques for collecting data and the use

of balance measures.

Jude & Maria Room 2

Coaching Workshop - 24 May 2017 Agenda

Time Topic Led By Room

15.00 Coffee

15.15 Creating and interpreting a run chart in Excel – how to create a simple run chart in Excel Emma 4a

Jonkoping – Improving ward flow through the ward collaborative Kevin & Tim Room 2

16.15 Close Jim Room 2

9.30 – 10.30

Laura O’Byrne

Nick Miller

Listening to the stories behind the numbers

and coproducing improvement with patients

Today’s session

• What is available to help us listen to patients

• Illuminate real patient experience data that is

readily available

• Explore how to undertake a patient care

experience flow map

• Consider how patient experience relates to our

Friends and Family Test dashboard

All STH services

conduct the FFT • A&E

• Outpatient

• Inpatient

• Community Services

• Maternity Services

Everyone in the Trust

can have access to

their FFT results

Positive ratings range

between 80 and 100%

positive in line with

National Performance

Themes for 5 Ps

FFT Comments – qualitative data

Comments reports – patients’ feedback in

their own words

Listening to our patients

Listening for the “but”

How to access the FFT Envoy website

Email Patient Partnerships to request your login

Lauren.belcher@sth.nhs.uk

Friends and Family Test Coordinator

Experience based co design

•Kings Fund toolkit

- Step by step guide

- Stakeholder engagement

- How to create patient videos

•Oxford study – trigger films are

effective too

Trigger videos available online

Themes currently available:

• A&E

• Asthma

• Atrial fibrilation

• Dementia

• Coordinating care

• Autism

• Diabetes type 2

• End of life care

• Ethnic minority mental health

• Experiences of unexpected

maternity care

• Indwelling urinary catheter

• Learning disabilities and the

health service

• Lung cancer

• Parkinson’s Disease

• Psychosis

• Raising concerns

• Stroke

• Young parents

• Young people and depression

Nick Miller

Patient shadowing & care experience

mapping

Objectives

• Gain an understanding of how to undertake

patient shadowing and care experience mapping

• Make connections between processes and

patient and family experience

• Link to opportunities for improvement

• Make links to coaching development

Value = Outcome + Patient experience

• Defined by the patient

- What does our care look like from the patients and

families point of view?

- Do we really know where they go and what they

experience?

- What do they think we do well?

- What do they want us to do differently and better?

- How do we find out?

Patient Shadowing

“You never really understand a person

until you consider things from his point

of view…until you climb inside of their

skin and walk around in it.”

Atticus Finch, in Harper Lee's To Kill a Mockingbird

Patient shadowing guide:

http://www.porthosp.nhs.uk/about-us/Perfect%20Care%20Week/pfcc-patient-and-family-shadowing-guide.pdf

Patient shadowing

• Shows the current state of care from the patient’s

view point rather than our own

• Opportunity for humble enquiry during

shadowing and in improvement meetings

• Opportunity to challenge assumptions and

‘normalisation’

• Helps us question how we communicate with

each other about the process of care

• Who shadow’s and how to get started?

• Visualisation of the shadowing

• Interpretation and coaching

• Meaningful application

• Opportunity for co-production

• Sustaining

Care experience flow mapping

• Define where to start and finish

• Be prepared to shift dependent on what patients tell you

• Display touch points

- Where they go

- Who they interact with

- How long it took

- How it felt

- what was the impact (+ve / -ve)

Experience Matters

Exercise

• At your tables

• Review the process map

• Review the patient story

• Construct a care experience flow map

Check in at

Reception

Sit in

Waiting

Called

to Blood

Height,

Weight,

Sample

Sit in

Waiting

See the

Doctor

Check out

Reception

Patient Shadowing

Exercise

• At your tables

• Review the process map

• Review the patient story

• Construct a care experience flow map

15 minutes then open discussion

Discussion

• What did you learn?

• What sense did you have about how the patient

felt, how his son felt?

• What conclusions do you draw for your own

coaching or work area?

Summary

• Experience matters to patients

• Patients want to tell us about their experience-

are we listening?

• There are different ways to start listening and

apply patient experience to enhance

improvement work

10.30 – 10.45

10.45 – 11.45

Mark Adams

A coaching story

5Ps to PDSA

Case Study –The Neuro Case Management

Service ( SHSC FT)

Meet the team

Work smarter not harder !

https://www.youtube.com/watch?v=2Dj196t5Sb0.

• Coach training cohort 5

• A team with a personal pre existing relationship and from within the same trust directorate

• A small team with an exponential referral rate and facing a challenge to manage the demand for their service

• A team that recognised that it needed to adapt to the demands that it was experiencing and was open to exploring how the MCA approach could be of benefit to them

Background to involvement with the MCA

Pre Phase – The Work Before the Work

• Started MCA training

• Met the operational team manager – expectation setting

• Launch meeting with the team

• Familiar with the work of the team and individual staff

• Agreement from the team to start regular microsystems

meetings

Finding time to meet

• Agreed to weekly hour meetings

• Changed to hourly meetings every other week:

• Enabling staff to carry out actions identified in the meetings

• Initially unable to engage all of the team in attending meetings

• Use of flip charts displayed in the shared office to enable all staff to

participate in key decision making.

Initial Meeting 13th May 2015

• Introduced what we mean by quality & quality improvement

• Introduced effective meeting skills and roles

• Set up the ground rules

What worked well?

•Better than expected

•Stayed focussed on the scope

•Agreed scope

•Good timekeeping (people here for prompt time)

•Good attendance

What could be improved?

•Circulate agenda before the meeting

General score: 7/8/9 out of 10

Meeting Evaluation

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

Improvement Ramp Global

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Dartmouth Microsystem Improvement Curriculum

Global Aim

Understanding the System

Assessment – 5 Ps

5p’s poster

Purpose

• What is the purpose of the microsystem?

Identification of needs and priorities of an individual as a result of their

neurological condition.

Request and co-ordinate the appropriate response to a particular need

and/or risk.

Provide direction for future management. This ensures an individual, or

service, feels more empowered holistically to guide input in a timely and

efficient manner.

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Target pressures

Caseload changes

Impact of service

changes

Key Improvement

Themes

Changes in referral patterns

job satisfaction

Key improvement Themes

Communication within team,

with clients and professionals

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Theme 1: Global Aim • We aim to improve the process of how we catagorise the complexity of

clinical cases.

• In the Neuro Case Management Service by the clinicians

• The process begins at referral or referral enquiry and ends with either

triage of the referral or at a review of the case.

• By working on the process we expect better equity of service to all service

users, less time spent by staff on clinically related administration, clearer

understanding of what case management is and the level of responsibility

that staff have, better prioritisation of staff members clinical caseload, more

efficient use of clinical time, increased clinician job satisfaction, a more

timely response for service users

• It is important to work on this now because of recent changes in referral

profiles and different interpretations of complexity of clinical case between

clinicians.

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Target pressures

Caseload changes

Impact of service

changes

Key Improvement

Themes

Changes in referral patterns

job satisfaction

Key improvement Themes

Communication within team,

with clients and professionals

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Specific Aim – September 2015

We will improve the job satisfaction of staff in

relation to the management of their clinical caseload

by 25%, by March 2016

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Fishbone diagram

PEOPLE PROCESSES

Risk: to with client and diagnosis Risk

Ethos: working Increase in processes that distract - Values from clinical intervention - Culture Difference of opinion: about care - Professionalism - Internal Reduced Admin workload - External therefore increased workload Feeling more involved in for CM’s Case Management Role face to face - What is it?

Other Services: expectations Allocation Triggers and targets towards Caseload mix leading to less - Improvement the front of intervention - face to face contact how referrals are nothing at the end allocated?

PROBLEM

Knowledge, Skills, Experience, Professional background IT Support

TPP & Insight - Information Non face to face Environment contact - small room

External Services

MATERIAL EQUIPMENT

E.g. Effect of

caseload mix on

staff job satisfaction

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Change Ideas

Benchmarking

caseload mix

and develop

staff quotas Develop a

clinical tool to

help clinicians

to manage

caseload

Develop a

better system

for allocating

to individual

caseloads

Change

timescale

targets for

different

stages of the

care pathway.

Global Aim

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Equity of service to all

clients?

Meeting externally set targets for timescales for service delivery?

Cost per case ?

Staff job

satisfaction

Value Compass

Stakeholder

perspective

We will improve the job satisfaction of staff in relation to the

management of their clinical caseload by 25%, by March 2016

Job Satisfaction Questionnaire

• 10 Questions including,

•How satisfied are you with using the current system of

categorising client complexity (resource requirement)levels?

Very unsatisfied 1 2 3 4 5 6 7 Very satisfied N/A

•How satisfied are you with your caseload mix?

Very unsatisfied 1 2 3 4 5 6 7 Very satisfied N/A

Global Aim

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

PDSA - Plan

• Development of a tool for clinicians to use with service

users to consistently evaluate the challenges to

delivering an effective care plan.

• 2 Neuro case managers to pilot the use of this clinical

tool at referral triage, before allocation to all 4 case

manager caseloads.

• Evaluate using a job satisfaction questionnaire specific to

the management of their clinical caseload. To be

completed by staff prior to implementing the caseload

management tool and then repeated after the

introduction of the tool.

Clinical caseload management matrix

Patient

Name: DATE: / /17

NHS No: Assess

Domains Risk totals

Risk Care and

Support Rehab Medical Equip &

Accom Future Care

Planning Advocacy Max score=12

Non engager 0 0 0 0 0 0 0

Over engager 0 0 0 0 0 0 0

Unrealistic expectations of client /

family 0 0 0 0 0 0 0

Insight / denial 0 0 0 0 0 0 0

Social Breakdown 0 0 0 0 0 0 0

Social care needs (inc CHC) 0 0 0 0 0 0 0

Multiple Co-Morbidities 0 0 0 0 0 0 0 Rapidly deteriorating condition 0 0 0 0 0 0 0

Mental Health 0 0 0 0 0 0 0

Mental Capacity 0 0 0 0 0 0 0

No identified Care Planner 0 0 0 0 0 0 0 Effectiveness of Services 0 0 0 0 0 0 0

Safeguarding 0 0 0 0 0 0 0

Domain Totals Max score = 26 0 0 0 0 0 0 0 Total

score Care and

Support Rehab Medical Equip &

Accom Future Care

Planning Advocacy

Notes at

time of

completion:

0 = No involvement or concern

1 = low risk

2 = high risk

Descriptors Feb 2017

Evaluating the outcome of the pilot

5P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

5 P Assessment

Global Aim

Change Ideas

Specific Aim

Measures

Global Aim

Standardise

•Following a review of the job satisfaction

questionnaire and reflective discussion it was

agreed to standardise the use of the caseload

management matrix.

•All 4 Neuro case managers use the clinical tool at

referral triage prior to caseload allocation, with

training on its use and written guidance.

•An STH team has adopted it’s use and SCC are

looking at it’s use within one of the social services

teams.

Guidance on completing the matrix

Risk Factors Definition Low High

1. Non-engager

Evidence of capacity to make decisions

and chooses not to engage with

services despite a need and to the

detriment of the management of the

condition. This is usually a chronic non-

engagement problem.

Will engage with a service who

CMS can liaise and link with re

management of situation /

manage risk and domain.

Evidence of multiple times of

non-engagement

Doesn’t engage with any service

despite seeing the need.

Difficulties exist due to

complexities across many

domains.

1. Over-engager

Frequent, inappropriate contact with

multiple services

Previously identified and

there’s a plan in place

Patient driven referrals to multiple

agencies and / or no plan in place

1. Unrealistic expectations patient/client

Psychological blockage / unrealistic

thought process that does not allow

progression of onward referral,

engagement of services etc. This may

trigger a referral to N/Psychologist

within CMS or LTNC Team. Unrealistic

expectation of what services can

provide (outside of service criteria)

Expectations can be managed

by education and concrete

explanations. Patient / care

system can self-manage the

outcome of education

Multiple attempts of explanation

with no change in expectations.

Indicates need for review of

system management due to

continued challenge

QUESTIONS?

11.45 – 12.45

Coaches Support Meeting

Using Troika Consulting

This Session

• Learn a new approach to support others

• Get some practical help and advice from the

wisdom of colleagues in the room

Troika Consulting

• Get Practical and Imaginative Help from

Colleagues Immediately!

• A 30 min process.

• http://www.liberatingstructures.com/

Troika Consulting

“To listen is very hard, because it asks of us so

much interior stability that we no longer need to

prove ourselves by speeches, arguments,

statements or declarations.

True listeners no longer have an inner need to

make their presence known.

They are free to receive, welcome, to accept.

Henri Nouwen

Troika

In quick round-robin “consultations,” individuals ask

for help and get advice immediately from two

others.

Peer-to-peer coaching helps with discovering

everyday solutions, revealing patterns, and refining

prototypes.

This is a simple and effective way to extend

coaching support for individuals beyond formal

reporting relationships.

How it works

Explore Problem & Help?

• 3 chairs

• No table

3 Rounds • 1 Client

• 2 Consultants

Sequence of Steps and Time Allocation

1. • Share and reflect on the consulting question

• 1 - 2 min

2. • Consultants ask the client clarifying questions

• 1 min

3. • Client turns around with his or her back facing the consultants

4. • Together, the consultants generate ideas, suggestions, coaching advice.

• Client takes notes.4-5 min.

5. • Client turns around and shares what was most valuable about the experience.

• 1-2 min.

6. • Groups switch to next person and repeat steps.

Benefits to the approach

•Refine skills in asking for help

•Learn to formulate problems and challenges

clearly

•Refine listening and consulting skills

•Develop ability to work across disciplines and

functional silos

•Build trust within a group through mutual support

•Build capacity to self-organise

•Create conditions for unimagined solutions to

emerge

Have a go…preparation (5 mins)

Think about a coaching problem you

want some advice or new thinking on.

Write down your problem in a sentence

Do you have any ideas/solutions?

Note them to quickly share

Have a go (30 mins)

1. Form groups of three.

2. 7-10 minutes per person.

3. Spend 1-2 minutes sharing your problem and

any ideas you have.

4. Turn your back. Spend 5-7 minutes receiving

feedback and advice from your consultants –

take notes

5. Turn back, and share what was most valuable –

Note the best ideas and suggestions on the

worksheet

6. Thank the consultants and switch

Coaching Support Round Issue Ideas & Suggestions

Have a go (30 mins)

1. Form groups of three.

2. 7-10 minutes per person.

3. Spend 1-2 minutes sharing your problem and

any ideas you have.

4. Turn your back. Spend 5-7 minutes receiving

feedback and advice from your consultants –

take notes

5. Turn back, and share what was most valuable –

Note the best ideas and suggestions on the

worksheet

6. Thank the consultants and switch

TROIKA DEBRIEF

•Problem solving at beginning or end of meetings

•After a presentation, for giving participants time to

formulate and sift next steps

•To help one another and to promote peer-to-peer

learning

•In the midst of conferences and large-group

meetings

•As a self-initiated practice within a group

12.45 – 13.15

13.15 – 14.00

Improvement Bazaar

14.00 – 15.00

Jude and Maria

Measurement - When you don’t know what to

measure

Structure of session

• Types of measure

• Case study example

• Your scenario and context

Get a baseline

• Looking back

• Start now

• Guestimate

Make it simple

• Is the data already

collected somewhere?

• Make it easy to collect

and with clarity

What to measure? – Process

What to measure? - Outcome

What to measure? - Balance

Exercise

• In groups around your table

• Read the scenario and answer the questions (10 mins)

- How would you approach getting a baseline?

- What would you measure for this change and how would you

approach this?

- Which of these measures could be used to measure the change?

Process, Outcome, Balance

• Feedback and discussion (5 mins)

15.00 – 15.15

15.15 – 16.15

Tim and Kevin

Improving wards through two different

approaches to spreading and sustaining

improvement

Sheffield MCA

•Hosted by Sheffield Teaching Hospitals

•Train QI ‘team’ coaches (143 so far from several organisations)

•Central team within the trust

•Organised into sub teams

• Project Management

• Building Capability

• Elective

• Non-Elective

Different views of the same thing..

Everyone sees part of

a more complex

reality……….

Sheffield Teaching Hospitals very own

Elephant!

1,035,094

112,855

152,539

1,188,903

Out-patients

treated

Inpatients treated in

2015/16

Contacts with Community patients

Accident and Emergency

Attendances

16,000 Staff employed

70+ Different professions

Each of us has seen and been part of exceptional

care and caring. But Improvement is hard to

sustain…and hard to link together

The challenge of sustaining improvement is well

documented. How can we do more, to enable teams

to improve more services for more patients?

Collaborative approach -

Two different approaches

Programme approach -

theatres

Aims of the Ward Collaborative

•To spread the approach and learning from the improvement approach adopted

in the Respiratory wards

•To build quality improvement capability with the staff on those wards so that

quality improvements can be maintained and improvement becomes

continuous during this period.

•To support and develop new MCA coaches working in the ward environment by

buddying them with experienced service improvement coaches.

•To create an opportunity for wards to learn from each other, share

improvements and good ideas to accelerate the rate of improvement for patients

•To support wards to improve care for the patients they serve by March 2016.

Timeline and Structure

Wards, Themes and Tests

TTO’s

Ward Environment

Daily Board Rounds

Case Note Standardisation

Senior Review

Patient Experience

E- Discharge

Noise Levels

Patient Information

Improved MDT Communication

Blood Result Redesign

Discharge Checklists

Improved ward flow Documentation

Junior Dr Induction and information Gastro

(RH3 & RH4)

(B5,6 & 7, RH5 & 6

Spinal (Osborn 3)

Spinal (Osborn 2)

Infectious Diseases

(E1 & E2 RHH) Orthopaedics (F1 RHH)

Communication Noise

Ward Process

Team Work

Pain Management

Discharge

Drug Round Redesign

Improved discharge

Summaries

Board Round Redesign

A clearer perspective….

Timely Assessment

Pull the right patient from assessment

Specialty consultants in teams –

consultant of many days, ward based

consultant.

All patients have a clear plan

Daily review of care plan to agree plan for

the day and daily goals.

Consultant approved care plan within 14 hrs of admission.

Regular MDT review of plans for patients with extended length of stay – home first

mindset. D2A

Improved ward flow and MDT

working

Daily Board rounds

One stop MDT morning ward

rounds

Ward round checklists

’E-Whiiteboard and handover

Patient Experience

Patient and carer involvement in ward

round, discharge planning.

Clear verbal and written

communication of the plan of care.

Patient involvement in improvement.

Shared Understanding of Opportunities and Challenges

Individual ward teams engaged in regular improvement meetings

Mesosystem

Microsystem

Before the ward collaborative….

Good foundations for sustainability?

• Co-coaching model helps

support ‘novice’ coaches

and aids ‘resilience’.

• Teams regularly sharing

ideas and challenges

supports spread and

sustain

“The sharing events - it was very useful to know that most other groups were struggling with participation

and that it could be overcome.”

“I hope it will become part of our culture that we pick up. There are lots of other things

that we need to apply the same principles to..”

“We have been doing some new things in the department and that is possible

only because there is a sense of direction that has been created by the Trust

and by our own local leadership”

“Interesting hearing from other wards – hearing stories, difficulties and

challenges.”

Team & Wards Themes PDSAs

(B5,6 & 7, RH5 & 6

Communication, Noise

Board Round redesign

E-discharge

Case note standardisation

Ward Environment

Gastro

(RH3 & RH4 NGH)

Patient Flow (timely discharge),

Patient Entertainment, Patient

Nutrition

Daily Board Rounds and Ward Rounds.

Junior doctor induction pack..

Patient entertainment – availability of a

newspaper/sweet trolley and working TV’s

Drug Rounds

Spinal (Osborn 2) Organisation, Ward Processes,

MDT ward round standardisation

Patient information & Food storage

Drug round redesign

Spinal (Osborn 3) Team Work

Ward documentation

Improving flow of ward round

MDT communication tests

Standardisation to reduce time wasted

TTO’s

Discharge Processes

Infectious Diseases

(E1 & E2 RHH) Ward attenders

Overall process redesign. New labelling for tests, diary

system, blood result redesign, patient tracking

TTO’s

Orthopaedics (F1

TED Stockings Process

Pain Management

Patients belongings

Tested stocking aid reducing delay in discharge. Test re

X ray process to improve pain management and

immediately start physiotherapy.

Joint School

Active PDSA’s

Geriatric and Stroke Medicine

The team used a

fishbone diagram to

identify the reasons for

e-discharge delays.

E-discharge is used to

essentially inform the GP

about the patients

medication and history .

A new discharge

checklist was introduced

and reminders were also

put up on the wards.

E-discharge compliance improved from 37 hours to

An intervention was introduced in

November: Consultants were asked to

release junior doctors from the board

and ward round to write TTOs early for

any patient identified for D/C that day.

This was only when staffing numbers

allowed. 4 juniors is considered

minimum staffing levels (1 junior per

team) when a junior can not be

released from the ward round to do

TTOs. This table shows the number of

junior doctors available on the ward

round and afterwards to do jobs. This

is a significant barrier to sustainability

of this improvement

Gastroenterology

Spinal Injuries

Weekly ward rounds were chosen as an area for specific improvement to address key challenges:

•Meetings not starting on time

•Not all MDT members recording feedback

•Difficulties around disseminating information gathered/discussed in the ward round meeting

•Not having a clear set of actions from the discussion

•Not fully understanding/appreciating other professional roles

• 100% of patients who have clear set

of actions agreed during the MDT.

• 30% increase in number of patients

that are discussed, seen, and have

agreed actions within 12 minutes

per patient.

• Significant decrease in time spent

to disseminate outcomes of MDT to

nurses caring for these patients on

the ward

The future……

Collaborative approach -

Two different approaches

Programme approach -

theatres

Microsystem Improvement work in theatres

Identify Available Technology

Process mapping of scheduling

and planning processes

Staff and Patient views

Best practice internally

and externally

• Consultant Anaesthetists &

Surgeons

• Senior theatre managers

• Theatre flow experts

• Service Improvement experts

the vision…

“To create a best practice, truly patient centred experience of elective surgery

where the referral to recovery process is right first time”

13 Seamless Surgery Principles

Once listed for surgery dates for future appointments (e.g. for pre-op or for surgery) agreed with the patient present or over the phone.

All appropriate patients will use electronic pre-operative assessment (ePAQ-PO)

Escalation plans are in place to address issues with upcoming lists (e.g. lack of equipment, staff or patients)

Scheduling meetings take place every week with staff from theatres, the Directorate with clinical input to plan theatre capacity ahead and review the lists for the following two weeks

Weekly root cause analysis is undertaken of the previous weeks on day cancellations

Electronic diaries to manage lists and to enable effective communication between teams

Alturos is used to plan lists in conjunction with the operating surgeon

Lists are uploaded to ORMIS two weeks before they take place

All patients are called four days prior to their planned admission, to ensure the they are fit, ready and able to attend

List orders are finalised and fixed 48 hours before admission

Operating teams are consistent with a regular core and appropriately skilled team

Operating teams agree and standardise the organisation of the theatre, equipment needed and specific staff roles

Theatre teams are supported to ensure lists start on time, turnaround times are minimised and the list finishes on time

The Launch – July 2016

• Half day theatre shut down

• Over 300 staff attended launch/workshop

• Senior Executive Presence and Support

• Mix of presentations, videos from patients and staff and opportunity to work in

MDT teams to discuss action plan

Post Launch

• Continued quality improvement training with focus on elective pathway

• Interactive game, helps staff see full pathway and experience from patient

perspective

• Set up weekly/fortnightly meetings to continue working on action plans

• Seamless Surgery Board

Seamless Surgery –

Post Launch

Neurosurgery

Perfect Lists

Electronic Pre-operative assessment has

enabled a one stop service for 450 patients

per month, whilst freeing up 430 hours of

face to face slots, delivered by senior

nursing staff

50% reduction in on day

cancellations in Orthopaedic

Surgery from 6% to 3%, meaning an

additional 3 cases per week

Improved

planning

meetings

Eradicated cancellations for high

blood pressure in Ophthalmology

through implementation of new

policy

ENT amended their waiting

form to include additional

information such as

procedure length and

overnight stay

New briefing process has reduced

late starts in many theatres across

NGH and RHH

Ophthalmology

get an inpatient

report to reduce

cancellations

Pre-op staff are working

towards standardised

working to reduce

variation in patient

experience and waiting

Cardiac theatres have

made lots of small

changes to their

processes to reduce

wound infections to 0

Seamless Surgery -

Next Steps…

Improved Visibility of

Key Metrics

Development of SOPs

for key parts of

Elective pathway

Reduction in

Patient

medication

Electronic waiting

list forms Continued roll out of

new briefing

process to reduce

late starts

Escort support

workers to assist

patient movement

Increased focus to

reduce on day

cancellations

Sharing and

Celebration Event

More Information….

@seamlesssurgery

www.sheffieldmca.org.uk/seamless-surgery

“While the literature often portrays an organization’s quest

for change like a brisk march along a well-marked path,

those in the middle of change are more likely to describe

their journey as a laborious crawl towards an elusive,

flickering goal, with many wrong turns and missed opportunities

along the way. Only rarely does an organization know

exactly where it’s going, or how it should get there.”

Kanter R.M., Stein B.A., Jick T.D.: The Challenge of Organizational Change:

How People

What we are learning…

Microsystem improvement engages people and help build motivation and improvement capability to tackle strategic challenges.

Building on this for wider system level improvement:

•No one size fits – different contexts need different approaches.

•Stick to the improvement principles whichever approach.

•Build a shared purpose.

•Clinical and managerial champions creating the conditions.

•Opportunities for teams to learn together and share.

•Simple organisational drivers/principles

•Visible metrics that matter.

Common Challenges

“It’s a bit like steering a super tanker isn’t it. You can’t just spin the steering wheel and turn it round You’ve got to do

gradual changes to make the whole thing improve. But people struggle to see what on a daily basis”

Communication

to wider team

“And you’d like to get different people to come

and get an experience but you really want

continuity because otherwise you spend half an

hour telling people what you’ve been doing the

week before. So it needs to be similar people

each time”

Resilience under

pressure

But its still getting them, oh I need this, I need to care

for this patient, I need to do that, and its difficult to

argue when you’ve not got many staff………..So we

are going to keep doing it , we will get better eventually,

we’re going to keep meeting every week and were

going to keep doing it. That’s what we’ll do”

Leadership

support

“We have been doing some new things in the

department and that is possible only because

there is a sense of direction that has been

created by the Trust and by our own local

leadership; if we apply the same principle it

should work.

Common Challenges

Timescales

“It’s a bit like steering a super tanker isn’t it.

You can’t just spin the steering wheel and turn

it round You’ve got to do gradual changes to

make the whole thing improve. But people

struggle to see what on a daily basis”

Opportunity and

Capability

In fact one of the most vociferous and active

members of our team is a support worker, very,

very, very good. She was the one who led the

survey and formulated the ballot boxes,

Measurement

I found it all really useful, stuff that I have

never thought of in such a way that you

analyze your work, obviously because there is

no point in doing a change and not actually

looking at whether it’s made a difference or not

A chance to reflect…

•What experience can you share about each of

these different challenges?

•As coaches what do we need to pay attention to?

•What ideas do you have about how to support

teams with these challenges?

• How can you share learning – what ideas do you

Common challenges as coaching

opportunities? •Communication to the wider team is problematic and variable - paying attention to who and when is key to ownership and engagement

•Opportunities to build capability exist – finding ways in partnership with teams to allow the right people to attend meetings is helpful

•Leadership support – different style of leadership – teams need permission

•Timescales are difficult to define – leaders and teams have a role in describing and linking the strategic direction and operational challenges with improvement work.

•Measurement even when the ward was going through some bad patches, the coaches persisted with encouraging the rest of the team. The persistence actually paid off

“And you’d like to get different people to come and get an experience but you really want continuity because otherwise

you spend half an hour telling people what you’ve been doing the week before. So it needs to be similar people each

week.”

“We have been doing some new things in the department

and that is possible only because there is a sense of

direction that has been created by the Trust and by our own

local leadership; if we apply the same principle it should

work. There’s no reason why it shouldn’t work.”

Back to Sheffield Teaching Hospitals very own

Elephant!

Reflections

Share your thoughts on the day…

Post it evaluation:

Dates for the diary

MCA Expo '17

5-6 June 2017

Sheffield Hallam University

Charles Street Building

MCA Connect

13 July 2017 (9.15-16.30)

Mayfield, SHSC

The next workshop in six months time – keep

an eye on the website

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