Botox for Children with Cerebral Palsy

It’s amazing how little changes can make such a big difference. At the end of the day its all about the patient, they are the focus and we need to ensure they remain at the centre of everything we do. Involving them in identifying and making these changes has been key to our success

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%. 
 

Their 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.

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 patient representative confirmed that the therapists often only found out that the child received Botox during a regular 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.

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 therapy 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:-

It’s great to see different members of the team working together

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!

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. At the end of the day its all about the patient, they are the focus and we need to ensure they remain at the centre of everything we do. Involving them in identifying and making these changes has been key to our success 

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.

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