CEREBRAL PALSY IMPROVEMENT

WORK PLEASES PATIENTS The ‘Botox for Children with Cerebral Palsy’

team administer Botox™ injections to

children with cerebral palsy and other

neuromuscular conditions during surgery

under general anaesthetic at Sheffield

Children’s Hospital. Following the procedure,

patients should receive prompt

physiotherapy to maximise the benefits of

the treatment.

The team called upon the Sheffield Microsystem

Coaching Academy for support in improving the

effectiveness of their processes, and Emma Smith

began coaching the team in May 2013. At first,

some members of the team were sceptical that a

coach would be able to improve the clinical

effectiveness of their work – but in less than five

months, the number of patients receiving

physiotherapy within 15 days of Botox™ surgery

had increased from 52% to 92%.

Our purpose:

To provide a seamless, equitable service

that is well-integrated for children with

cerebral palsy receiving Botox™ to help

improve their quality of life.

appointment, often long after the treatment had

been administered. This lack of clear

communication resulted in the Botox™ injections

being redundant, and it became clear that this error

was not uncommon. One parent said “Without

clear communication the treatment is pointless, and

puts my child through unnecessary anaesthesia with

zero benefit.” At their fortnightly microsystem

team meeting, the team acknowledged that

communication was the key issue within the team

and sought to improve this in order to ensure the

patients received timely and effective therapy input.

As part of the assessment phase of the improvement process, the team

were encouraged by Emma to invite a parent of a patient to be part of

their improvement group to ensure the changes they made were going to

benefit the patient. The parents informed the team that physiotherapists

often only heard of the child receiving Botox™ during a regular therapy

The team identified clear bottle necks and points for concern though

tools such as process mapping. This identified a number of changes

required to the patient pathway which would make a considerable

improvement towards the goal of every patient having timely access to

physiotherapy after receiving Botox™.

This improvement process highlighted to consultants and therapists the

benefits and importance of therapy, and the impact on patients and their

families when poor communication reduces clinical effectiveness. The

microsystem improvement work has given insight into things that the

team didn’t even realise were issues, such as the lack of an information

booklet for patients on what to expect following the Botox™ treatment.

The work has helped the team work more closely together, understand

the different departments involved in the process and the impact they

have on the pathway. This process has been helpful for removing the

barriers between the different professionals within the multidisciplinary

team.

The team have really valued having an improvement coach to support them. Physiotherapist Helen noted that she

“wanted to make improvements, but didn’t know how”, and that coaching has given her the forum to improve the

system for patients. Comments from other departments and professionals outside the lead improvement team have

been positive, with one colleague expressing that “it’s great to see different members of the team working together.”

It’s great to see different members

of the team working together

The Sheffield Microsystem Coaching Academy

has now trained 50 improvement coaches

across the Sheffield health system, and is

currently developing the third cohort of 16

new coaches. Applications for cohort four

are now available on the website, with a view

to starting the course in February 2014.

Teams interested in welcoming a coach to

their service area can also apply to be

coached via the website.

Author: Adam Kirton

Sheffield Microsystem Coaching Academy

2 Claremont Place, Sheffield, S10 2TB

For further information:

patrick.richmond@sth.nhs.uk www.SheffieldMCA.org.uk

The changes that the team have implemented are only small at the

moment, but Emma is keen to point out: “It’s amazing how little changes

can make such a big difference.”

Coaches work with teams until they are comfortable using some of the

coaching skills and improvement tools and processes without the

assistance of a coach. At this point, there is an element of improvement

capability within a team and they can continue to test and measure

changes to improve the system. This approach is certainly not a quick

fix, but the longer term implications can be quite profound for delivering

quality care to patients and improving the workplace for the staff.

It’s amazing how little changes

can make such a big difference

Get on microsystems —

it’ll sort your problems out!

Emma Smith who has been coaching the team for just over five months

is keen that the work will continue once she transitions away from this

microsystem and starts working with another team. The Lead

Consultant is keen that the work is continued as it allows the

multidisciplinary team to come together and make continuous

improvements for the patients.

Senior Administrator Helen often doesn’t get to discuss patient care with

her clinical colleagues, and has enjoyed working closely with them to

improve the system. She said, “I’m going to miss everyone if the

meetings stop.” Helen is also an advocate for the microsystem

improvement methodology, and is regularly telling her friends, “Get on

microsystems – it’ll sort your problems out!”