An introduction to the MCA and

the MCA Ward Collaborative

Jim Chapman, MCA Manager

Nicola Platts, Programme Manager, Service Improvement

Osborn 3 Ward Team

Hans Aubeeluck, Andrea Patterson, Claire Trask,

SI Coaches: Kevin Firth, Tim Sands.

• What is this all about?

• What is a microsystem?

• What is the Microsystem Improvement Academy?

• Does this work?

• What happens and how does it feel to be

coached?

Quality Improvement

The combined efforts of everyone to make

changes that will lead to better patient

outcome, better system performance, and

better professional development.

“What is “quality improvement” and how can it transform healthcare?” Qual. Saf. Health Care. 2007

February; 16(1): 2–3

Paul B Batalden and Frank Davidoff

Microsystems

• 1992 – Quinn – ‘Intelligent Enterprise’

• Studied the ‘best of the best’

• They are organised around the frontline

interface with the customer

• ‘Smallest replicable unit’

Microsystem

• Nelson, Batalden, Godfrey 2000 – 2007

• Looked at the characteristics of high

performing clinical microsystems

• Formulated a curriculum to develop high

performing microsystems

High Performing Microsystems

Information

&

Information

Technology

Staff • Staff focus

• Education &

Training

• Interdependence

of care team

Patients • Patient Focus

• Community &

Market Focus

Performance • Performance

results

• Process

improvement

Leadership • Leadership

• Organizational

support

What is a Clinical Microsystem?

• ‘The Place where Patients, Families and

Clinical Teams meet’

• The essential frontline building blocks of any

healthcare system. It is where the quality

is delivered.

It’s where everything happens with, for and

to the patient and family

Micro, Meso, Macro

Chest

Medicine

STH

Team Coaching

Improvement

Science

Microsystem

Improving Microsystems – The Elements

QI

18

Why Team Coaching?

• Develop a culture of continuous improvement

• Establish shared ownership

• Build improvement capability at the front line

Coaching Intensity Over Time

“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. Connecticut

Ownership not Buy In

‘Improvement in health care is

20% technical and 80% human’

Marjorie Godfrey, MS, RN

The Dartmouth Institute For Health Policy and

Clinical Practice

People and Behaviours

Quality Improvement

- The structure

Assessment - 5Ps

Diagnosis - Change Ideas

Treatment

- PDSA

SDSA

‘Standardise’

The Start of Microsystem

Improvement

Really important!

Why do the assessment?

Understanding the System

Assessment – 5 Ps

The “5Ps Poster”

The “5Ps Poster”

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Dartmouth Microsystem

Improvement Ramp

Effective Meeting Skills

Roles

Rotated at each meeting

– Leader - leads the team through the agenda

– Note taker - records brief notes & action

points

– Time keeper - ensures meeting runs to time

– Facilitator - makes sure everyone is involved

(best meeting

ever!)

What went well? What could be improved?

(complete

waste of my

time!)

0 1 2 3 4 5 6 7 8 9 10

Evaluation

Effective Meeting Skills

1 hour weekly

It works, recent examples:

The cataract team have

improved their patient pathway.

Patients now spend around 80

minutes at hospital through the

new process, a reduction of

50% on the previous process.

In Community Stroke a

microsystem project has

led to a 44% reduction in

average waiting times for

Physiotherapy.

The Geriatric and Stroke Medicine

team looked at their E-discharge

process and by introducing a

reminder they have reduced

average time that its completed

from 42 hours to 13 hours.

By looking at re-

scheduling in Pre-op

and ENT a total of 31

more assessments

were made available to

patients.

A Community Respite Unit

has reduced length of stay

from 47 to 24 days

Outcome – Length of Stay

Sheffield Microsystem Coaching Academy

Sheffield MCA

• Hosted by Sheffield

Teaching Hospitals

• Train QI ‘team’ coaches

(143 so far from several

organisations)

• 6 month programme –

experiential learning

• Coaches work with

microsystem teams to

make improvement and

build capability over 12

months+

Initial Testing in 2009 -10

Falls Clinic & More

2010

Shine Grant 2011 – TDMIA (2 CITs)

MCA bid Feb 2012

Cohort 1 – Sept 2012 (27 CITs)

Cohort 2 – Feb 2013 (19 CITs)

Cohort 3 – Sept 13 (14 CITs)

Cohort 4 – June 14 (21 CITs)

Cohort 5 – Feb 2015 (29 CITs)

Cohort 6 – October 2015 (30 CITs)

MCA timeline 2009 - 2015

Initial

testing...and

failing

Coaching

and success

Dartmouth

training

MCA HF bid

STH and

SCH with

Dartmouth

SHSCT join

WHSCT (NI)

join

Sheffield

CCG &

Lanarkshire

join

East Kent,

UCLP &

Tower

Hamlets join

Some Numbers

• 143 Coaches have graduated from the MCA –

Cohorts 1 - 6

• 793 Staff have attended the ‘Introduction to Quality

Improvement’ courses

• 140 microsystems have worked with an MCA coach

• The MCA website was hit over 14,564 site users

from 10 countries - 61,653 page views last year.

• 220 staff attended MCA expo in June 2015

RHH

S

WPH

JW

OSSCA Spec Med &

Rehabilitation

Head &

Neck

Emergency

Care

Corporate

Surgical Services

Emergency

Care

Surgical

Services

Spec Med &

Rehabilitation

SYRS

Corporate

LEGION

Combined

Community & Acute

Corporate

MSK

MSK

Combined

Community & Acute

FLOW

CC

Ward improvement work pre Ward Collaborative

• Attempted by 8 coaches and ward teams in

Cohorts 1-4

• Majority said it was worthwhile but high failure

rate by 12 months

• Main issues – time to meet, leadership

engagement and enablement, coach support

• Only the Respiratory team achieved sustained

system level change

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

Improvement Ramp

Effective Meeting Skills

Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Dartmouth Microsystem Improvement CurriculumPre Ward Collaborative MCA

‘Ward’ teams at 12 months B3

F1

Green - Active

Red - Inactive

MCA Ward Collaborative Aims

• To start small - support up to 6 wards at STH to

improve care for the patients they serve by March

2016.

• To build quality improvement capability of ward

teams.

• Buddy new MCA coaches with experienced SI

coaches

• Provide opportunities for ward teams to learn from

each other, share improvements and good ideas.

Ward Collaborative Overview

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart

Cause & Effect

The Microsystem

Improvement Ramp

Effective Meeting Skills

Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Dartmouth Microsystem Improvement CurriculumWard Collaborative MCA teams

at 12 months GSM

x4

F1

Green - Active

Red - Inactive

Improvements

What are we learning - Positives

People power – over 100 front line staff engaged

Collaborative helps build capability, rhythm and

pace for sustained improvement

Develops QI understanding and ownership

Co-coaching model helps support ‘novice’

coaches and aids ‘resilience’

Teams regularly sharing ideas and challenges

supports spread and sustain.

What are we learning - Challenges

Conditions remain challenging – operational

pressures do not always allow staff to meet and

work on improvement

Communication to the wider team from the core

improvement group is problematic and variable

Timing of sessions is tricky – teaching what the

teams need at the right time

Measurement is a challenge – outcomes are

measured but many ward processes are not

routinely measured

MCA Coach comments “There is real value in

feedback, sharing ideas

and in reassurance

about pace”

“The Co-coaching

has been most

valuable, instant

feedback - asking did

I talk too much!”

“We’ve realised that this is

not linear & QI doesn’t fit

into boxes, we took it

back to basics and met

the ward where they are

at and tried to keep things

simple”

“It has been great

to see what

happens with a

whole system

view”

Ward Team Comments

“Interested in what other wards have

been doing (we are all the same)”

“Sharing experiences,

problems and

remedies”

“Meeting new people and

having different ideas”

“Excellent time to network and

exchange ideas

End of course -team self assessment

5 of the 6 groups (10 wards) were

• holding weekly improvement meetings using effective meeting skills.

• could independently of the coach

- select themes for improvement

- set global and specific aims

- process map

- develop change ideas and plan and run PDSA cycles

Hans Aubeeluck, Andrea Patterson, Claire Trask,

SI Coaches: Kevin Firth, Tim Sands.

Osborn 3

Ward Collaborative