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:
[email protected] 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!”