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A widely accepted definition of Quality Improvement is: 

“The combined efforts of everyone-health care professionals, patients and their families, researchers, commissioners, educators-to make changes that will lead to better patient outcome, better system performance and better professional development.” Paul Batalden and Frank Davidoff

Clinical Microsystems is a quality improvement approach which originated at the Institute for Health Policy and Clinical Practice, Dartmouth College, USA. It is a pragmatic and intuitive approach that has been used widely in healthcare settings which places the patient and healthcare worker at the core of improvement activities. This approach has also been adopted by Sheffield Teaching Hospitals NHS Foundation Trust where a Microsystem Coaching Academy has been established. Clinical Microsystems was originally introduced in Ireland in 2013/2014 as a training program offered through the Emergency Medicine Programme (EMP) to staff in Emergency Departments throughout the country. There were many great improvement initiatives developed by front-line staff as a result of this training with some groups still actively engaged in the work.

Here in Ireland some examples of results to date include:

1. Team performance and staff well-being:

  • Staff engagement programme to re-humanise healthcare in the ED
  • Mindfulness and resilience projects for staff
  • Improved staff communications through daily huddles
  • Increase in rate of notes completed after decision to admit rose from 37% to 67% 

2. Efficiency and value Projects:

  • Catering project to rationalise meal costs
  • Improve 48 hour turnaround for repair of faulty equipment from 37% to 80%
  • Reduction of 50% in the number of unnecessary escorts by nursing staff to X-ray departments
  • Locked docking stations for wheelchairs  to reduce time spent searching

3. Patient Experience and Improved care:

  • Comfort packs for admitted patients who need to wait in ED
  • Protocol for administration of paracetamol at triage to meet the National KPI of time to analgesia
  • Dementia friendly cubicles
  • Reduction in length of stay of admitted patients in the department by 47%
  • Investigations protocol
  • Patient information leaflet that explains triage, visitor guidelines, meal times and feedback procedure

What is a Microsystem?

This improvement approach focuses specifically on working with front-line staff within a department or unit where staff can work on improvement initiatives specific to their area and their patient population. A microsystem can be described as:

  • a small front-line unit for example the Emergency Department where health care is provided and where healthcare providers, patients and their families meet.
  • Microsystems are the essential building blocks of the larger organisation
  • They are the place where patients and the care teams meet

This approach aims to improve the quality of patient care and the work life of all staff. It also stresses the importance of linking each microsystem with other Microsystems or specialities in the hospital to improve the patient pathway. Supporting microsystems also exist, for example information technology, pharmacy departments etc.

Improvement Projects

Some examples of project work through Microsystems which were developed in Sheffield Teaching Hospitals highlight the initiatives taking place in other countries. In Sheffield, these were led through their Coaching Academy:

  • Orthopaedic Team Lower Limb Arthroplasty Project-the orthopaedic theatre team made a 33% increase in case list procedures carried out by applying the microsystems improvement methods
  • Geriatric and Stroke Wards Team improved e-discharge compliance from 37 to 11 hours, standardised medical and nursing notes, improved board rounds and reduced noise levels on the wards thus providing a more therapeutic environment for patients ,staff and carers
  • Nurse-led anti-coagulation services are improving referral pathways, addressing clinic capacity issues, re-evaluating dosing processes for patients, improving service users queries pathway and improving the use of information technology.

If you are interested in this type of work please contact:

Lisa Toland, Microsystems Facilitator, Quality Improvement Division, HSE and Emergency Medicine Programme, Tel. 087 3686842

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