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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.
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• 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?
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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
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Microsystems
• 1992 – Quinn – ‘Intelligent Enterprise’
• Studied the ‘best of the best’
• They are organised around the frontline
interface with the customer
• ‘Smallest replicable unit’
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Microsystem
• Nelson, Batalden, Godfrey 2000 – 2007
• Looked at the characteristics of high
performing clinical microsystems
• Formulated a curriculum to develop high
performing microsystems
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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
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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
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Micro, Meso, Macro
Chest
Medicine
STH
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Team Coaching
Improvement
Science
Microsystem
Improving Microsystems – The Elements
QI
18
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Why Team Coaching?
• Develop a culture of continuous improvement
• Establish shared ownership
• Build improvement capability at the front line
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Coaching Intensity Over Time
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“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
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‘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
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Quality Improvement
- The structure
Assessment - 5Ps
Diagnosis - Change Ideas
Treatment
- PDSA
SDSA
‘Standardise’
The Start of Microsystem
Improvement
Really important!
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Why do the assessment?
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Understanding the System
Assessment – 5 Ps
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The “5Ps Poster”
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The “5Ps Poster”
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5P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
Flowchart
Cause & Effect
The Dartmouth Microsystem
Improvement Ramp
Effective Meeting Skills
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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
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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
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Outcome – Length of Stay
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Sheffield Microsystem Coaching Academy
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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+
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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
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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
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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
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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
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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
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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.
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Ward Collaborative Overview
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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
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Improvements
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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.
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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
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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”
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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
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Hans Aubeeluck, Andrea Patterson, Claire Trask,
SI Coaches: Kevin Firth, Tim Sands.
Osborn 3
Ward Collaborative