Hearing Services (SCH)



The Hearing Services department at SCH requested help from the Continuous Improvement team as they had some major changes to the way their department coming up including cross site working and changes to staffing. The manager of the department also wanted a comprehensive review at the department and for the staff in the department to learn something of Service Improvement skills and approaches. Because of these factors it was decided that the Clinical Microsystem approach was the appropriate methodology to employ.

The team consisted of the following staff:

  • Department manager (Project Lead)
  • Audiologists
  • Clinical Scientists
  • Administration manager
  • Apprentices
  • Lead Consultant

There were 15 members initially but after the first few weeks the team the membership stabilized at 11 members with between 6-8 attending each session.

The team met every Wednesday between 5-6pm to enable clinical staff to attend after their clinics had finished.

In addition to the weekly meetings there was also a standing agenda item on the monthly full department meeting to share progress with the wider team and a 2 hr slot on the bi-monthly audit time in order to progress work with the full department.

5p’s Assessment

Following the MCA improvement ramp the team took time to collect and analyse the 5p’s data from the department.
The data collected included:

Patient and staff surveys, Process maps, Activity data and financial data.

The 5p’s data indicated that:

  • There was a high level of patient satisfaction with the department and the care provided was of a high quality
  • There were a high number of clinics cancelled or rearranged
  • The clinics were not operating at their potential
  • The processes and flow were hampered by the IT systems
  • Some of the departmental processes, particularly around the clinical workshop, could do with improving

Aims for improvement

After analysis and interpretation of the the 5p’s data the team came up with the following Global aims:

  • To reduce the amount of clinic appointments that were cancelled by the Hospital every month
  • To support and provide evidence for a business case to upgrade clinical IT systems
  • To improve the way the Hearing Services workshop is managed and run


The improvements made were thought up by the Improvement team, shared with the full team and then implemented using Plan Do Study Act (PDSA) cycles to test and iteratively refine them.

The most significant change was redeveloping the way in which staff leave was scheduled and clinic cover re-arranged. This led to a decrease in the number of patient appointments cancelled by the hospital - from an average of 22 a month prior to intervention down to 13 per month (41% decrease)

Other improvements include:

  • Setting up a database to record inventory of hearing aids and to process requests for repairs in the workshop.
  • Reduces the need to hold too much stock and reduces the time it takes to administer repairs from 15 to 2 minutes per case.
  • Changes to working practices - quiet time in workshop when staff are not to be disturbed when working on repairs or with patients. Previously many interruptions had led to poor patient and staff experience. Staff now reporting that this makes things better for both staff and patients.
  • Introduction of outcome forms for clinics to make it easier for administration staff to book follow up appointments.
  • The team helped provide evidence in support of a business case to renew the PAS (Patient Administration System) to bring it in line with other areas of the hospital. This has now been successfully implemented with help from the Microsystem. This has improved safety for patients with more centralised records and improved working practices for clinical staff who are now able to view information.
  • The department had also recently moved from block contract to Payment by Results and wanted to be able to evaluate their throughput as a result. Through the Microsystem the team learnt the tools to be able to correctly analyse and interpret activity and financial data and as a result are now able take action in order to help meet their targets as needed.
  • Going through clinical Microsystems seems to have fostered a positive and proactive attitude within the department. Staff are now confident is coming up with new ideas and have the skills and knowledge to understand how to measure and trial them appropriately. Improvement has became a standing agenda item on all team meetings – even when not in formal project mode.


Further work

As a result of going through the improvement ramp the microsystem team in Hearing Services have just launched a new project based around the theme of improving the processes and experience for patients with Hearing Aids. Improvement aims include:

  • Seeking to reduce the amount of times patients are brought back for review (currently feedback is that they are seen more than clinically needed)
  • Reduce the amount of patients that are seen under the care of a Doctor when they could be seen by an Audiologist – freeing up the more limited and expensive Doctor slots.
  • To improve the experience of patients transitioning to adult services by providing structured
  • They are currently leading this new project with little input from the MCA Coach which is a testament to how applying the methodology well can help teach improvement thinking and skills.


The most important change made was redeveloping the way in which staff was scheduled – leading to a 41% decrease in hospital cancellations. Other changes were fairly modest are fairly modest but still enough for the team to feel that it was definitely worthwhile going through in terms of time spent compared to outputs.

Staff feedback included “Helps give us dedicated time to focus on change”, “Makes us be more objective over our own issues”, “Helps the whole team see the picture of how we work”. Staff feedback after each meeting on how useful the meetings were gave a mode average of 8/10.

Going through Microsystems has also helped the team become aware of their surroundings, identify potential problems earlier and start to develop their own culture of service improvement.

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