TitleImprovement in the Cystic Fibrosis (CF) Outpatient Department Microsystem at Sheffield Teaching Hospitals Trust.
AimTo optimise the quality of care to enable patients to lead as normal life as possible. From analysis of our system we identified the first major theme for improvement as clinic flow. Attendance at clinic is associated with practising preventative therapy than rescue treatments and allows maintenance of good health for longer in patients with CF.
MethodologyClinical Microsystems (CM) approach was used to; understand our system, identify problems, plan change. The microsystem team were coached by a Dartmouth Institute trained microsystem coach.
The microsystem team developed their own fictional patient based on the Esther project model. The fictional patient was called Brandon, he is 23 years old and lives in Sheffield. He wants to lead as normal life as possible.
ActionsAll staff who contribute to the microsystem were involved; medical, nursing, clerical, professionals allied to medicine, managerial. Patients were surveyed at each clinic appointment and representation at improvement meetings sought.
We reviewed our 5P’s; Purpose, data on Patients (demographic details & satisfaction survey results), Professionals (and what jobs & roles they carried out), the clinic Process (from making an appointment through clinic attendance and home again), Patterns from our data (referrals to clinic, frequency of follow up, DNA rates).
This revealed that patients were waiting for long periods during clinics. Patient survey data showed waiting time to be associated with high levels of frustration. We implemented a new clinic structure and carried out Plan, Do, See, Act cycles to assess impact. Patients recorded on supplied paper the times; they arrived, spent with different health care professionals, undertaking procedures. We mapped this data onto Gantt charts and reviewed; total time in clinic, time spent waiting, time spent with members of the team.
On the basis of this we restructured the sequence that patients saw the different members of the MDT and allocated estimated time for them. This time was derived from previous data collection and set at 80% of maximal time spent with the patient.
ResultsData of patient’s; total time in clinic, time spent with different members of the MDT, time waiting, ‘Did not attend’ (DNA) rate was collated. Time spent waiting reduced from a mean of 39.3 minutes to 8.5 minutes, with no impact on clinical time. DNA rate fell from 20.6% to 8.7%. Patient and staff satisfaction improved.
Steve Harrison
Dr Tom Downes
Dr Sally Davies
December 2012