Sheffield Wheelchair Service
To contact the Sheffield Wheelchair Service please call 0114 2715807
In July 2014, Angela Green (Improvement Programme Manager) approached Sheffield Teaching Hospitals NHS Trust to discuss supporting the Sheffield wheelchair service team with Improvement. It was agreed in collaboration with the Sheffield Teaching Hospitals Microsystem Coaching Academy that Angela would provide coaching to this team as part of the cohort 4 microsystem coaching course. This case study summarises some of the key areas of progress made by the team.
Work included meeting the directorate manager, initial meetings with service manager and clinical lead and securing agreement with the business manager regarding data sharing support. Two site visits to the service to see both admin and clinical teams in action were also completed. A whole team open meeting was held (12 attended) to introduce the concept of improvement work and to start the team on a shared exercise. A group of clinicians and admin staff agreed to start a weekly improvement meeting in August on Thursday morning 8.30 -9.30 am. They agreed meeting ground rules, agreed to use effective meeting skills rotating the roles weekly, organise their own notes and relationships began to build between the team and coach.
Understanding 5 P’s Work (August): What are and who are the microsystem: Purpose, Patients, Processes, Patterns and Professionals?
The team started to explore their processes, patterns, patients, professionals and purpose, mapping these out on a poster (as above) on the staff corridor wall so all could contribute and participate.
Work included a staff satisfaction questionnaire and a patient point of contact survey as well as exploring what measures are available for their processes and outcomes. They then used this work to reflect upon what the issues where in their system and how these were connected to the 5P’s evidence they had collected so far and identifying what information was still missing.
In early Sept they held a meeting exploring and agreeing the Global aim of their improvement work as follows:
We aim to improve:
- Timeliness of provision
- Patient satisfaction
- Reduce number of complaintsIn
In: Sheffield Teaching Hospitals Wheelchair Service
Process begins with: A referral received into the service
Process ends with: Completion of delivery of equipment and / or advice/education to the patient
By working on this we expect: Reducaed number of complaints, improved patient satisfaction, improved staff satification, improved team working, reduced wasted time on unnecessary work
It is important to work on this now because: We are currently under pressure due to low staffing issues, we need to achieve future target of 18 weeks
The team were supported to develop and operationally define some improvement measures for creation of improvement run-charts on time to provision of wheelchairs for different pathways such as manual wheelchairs and powered wheelchairs and data fields were requested but not yet provided. When exploring reasons the team were concerned about the quality of the data and the way in which it could be misunderstood. Work began positively however on improving data quality and processes of recording onto information systems.
The team explored some work on cause and effect of delays and complaints in relation to delays to equipment provision. They were introduced to fishbone diagram to support exploration of the contributing factors to delays in pathways of wheelchair provision and from this exercise then did some brainstorming to decide and agree as a team on their first specific improvement aim.
First specific improvement aim agreed:
We will decrease….
The number of reworks required from any clinical assessment reports
(including files and face to face contacts)
From : median 8 from baseline run-chart
To : median 4 (50%) by 1ST Jan 2015
They decided to focus on reworks. A rework is where information from a clinical assessment is either incomplete or inaccurate and therefore case records have to be passed back to clinical team from admin for correction before coming back to admin team to action next steps.
They started the plan for their 1st team PDSA which included them exploring the problem more closely and trying to understand what success would look like as follows:
Plan, Do, Study, Act (PDSA) Cycle
Specific Aim of 1ST test of change
Decrease reworks from clinical assessment reports (files and face to face contacts)
Develop some recommendations of information which need to be included in all report recommendations from clinical assessments.
Team to develop initial set of recommendations to be tested.
All clinicians to use the list of recommendations when completing reports/recommendations following assessments files/clinics/visits.
Why this test?
· Currently variance in what information provided and how it is recorded by clinicians
· Key information is not always completed fully or is missing
· Variance in format of information passed back to admin
· Admin staff needing to chase clinical staff for correct information
· Current delays contributing to longer waits dealing with reworks as file back to clinicians and then back to admin
· Reworks result in increased numbers of files/queries which need to be re-addressed therefore delays next required actions in the pathway
What will success look like?
· Reduced number of reworks caused by insufficient or missing information
· Improved communication and information flow between clinical and admin teams
· Reduced stress, less hassle and reduced interruptions
· Improved team working
· Reduction in unnecessary work
· Reduced number of files for clinicians to deal with
Plan to start on 6th October 2014. To discuss progress weekly with review of data 2 weekly.
The team worked together clinicians and admin to agree the list of recommendations to be tested for the 1st test. The team made two further minor updates of the recommendations after the initial test in 1st 2 weeks.
As part of planning this test of improvement the team considered how they were going to measure success of this test of change and they decided to explore the number of records requiring review which are recorded within the electronic information system. These are called reworks.
An initial baseline dataset (Feb 14 –Sept 14) was shared and discussed with the team and whilst it became apparent there were differences in how some staff defined and recorded a rework it was felt this was the most appropriate measure to use.
The step change in the chart shows that the team were successful in achieving their first test of change by achieving a 63% reduction in numbers of records requiring review due to missing or incorrect information. This improvement in flow of information contributes to reduced delays in time to provision of equipment.
The team have now became more familiar with looking and understanding variation of their data and have started to explore other areas of planned improvements.
They have successfully learnt, planned, tested and measured a small change of improvement in their system and successfully reduced some delays in a process which contributes to delayed provision of wheelchairs.
They have successfully worked on an area of improvement together including both admin and clinical staff and report improved team working relationships.
Using this microsystems approach has helped the whole team to understand their system processes and how they all interact with each other. At the one hour weekly meetings they have practiced and embedded the use of efficient meeting roles to help them learn how to achieve best use of their meeting.
They have learnt about measuring improvement, using run charts and how to develop data definitions.
They move towards being independent improvers by continuing to hold a weekly team improvement meeting (1 hour) and are moving forwards to plan their next tests of change.
A quote from a clinical team member:
“I have really enjoyed the sessions and it has taught me a lot on how to conduct and deliver improvement work. It has given our service a format for dealing with things that aren't working well and forming a solution to try and make them work better.
We are keen to continue it.” Occupational Therapist
In line with national future NHS England requirements in July 2015 for all services to provide data on “time to provision” of wheelchairs, the trust is supporting the Sheffield service to enable accurate recording and extracting data which will be of huge importance to informing and measuring future improvement.
For further information about this project contact:
Angela Green (Improvement Programme Manager)
Improvement Academy (part of YHAHSN)