Project Plan

What is a clinical microsytem?
The Clinical Microsystems methodology was developed by The Dartmouth Institute for Health Policy & Clinical Practice, New Hampshire USA. It has been used globally to develop sustainable healthcare improvements in quality of care and efficiency. The approach sees health organisations as being made up of small building blocks (microsystems) that come together to provide care. The coaching programme supports individuals within a microsystem to achieve healthcare improvement through learning and adapting improvement knowledge, developing skills and abilities, receiving encouragement and seeing improved group dynamics.

The initiative to develop the first UK Microsystems Coaching Academy (MCA) is being led by Sheffield Teaching Hospitals NHS Foundation Trust, (STHFT) in partnership with The US Dartmouth Institute Microsystem Academy, Sheffield Health and Social Care NHS Foundation Trust, (SHSC) Sheffield Children's NHS Foundation Trust (SCH), and the NIHR Collaboration for Leadership in Applied Health Research and Care South Yorkshire, (CLAHRC SY), who are evaluating the project. The Trust, in partnership with CLAHRC SY has received £420,000 funding from the Health Foundation, Shared Purpose Initiative to develop the Microsystems Coaching Academy. 

The clinical microsystem approach has already been shown to be an effective method for quality improvement, (Nelson et al 2002, Jackson et al 2009). This evaluation will focus on the development of the individual coaches and their teams in the MCA, rather than evaluating the clinical microsystems approach. However, in recognising that the success of the MCA will be dependent on the success of individual microsystems, the evaluation will include consideration of the impact of individual microsystems on the organisations as a whole

Aims
The overall aim of the MCA is to develop coaching capacity that enables corporate and support services to work in collaboration with clinical teams to achieve continuous quality improvement. The project sets out to develop capability to improve quality, including efficiency, through clinical teams rethinking how they deliver services to improve patient care and patient experience. 

Developing the Microsystems Academy in Sheffield 
The Dartmouth Institute Microsystems Academy will initially coach staff within STH and SCH. Coaches trained in the microsystem methodology will then offer coaching services to the wider health economy within Sheffield. The Trust's Service Improvement Team will take the lead in establishing the Microsystem Coaching Academy, which will then train and support microsystem coaches within the Trust's own workforce. Over three years the project will train around 125 coaches. Every six months this training will support 30 new micro system coaches, across clinical and corporate support areas, reaching the 15,000 employees of STH and SCH. The coaches will then produce 30 new improvement microsystems every six months. The end result aims to be a culture of sustained patient-centred continuous quality improvement within Sheffield Teaching Hospitals and Sheffield Children's Hospital. 

During the set-up phase from October 2012 – April 2013, a team from The Dartmouth Institute will adapt its Coach-The-Coach curriculum and come to Sheffield to deliver it. This five-month course includes:

• Five learning sessions (one in person and four web based) lecture materials,
• Handouts and workbooks;
• Individual and group coaching mentorship experiences;
• Accessible and timely academic and technical support.

The Sheffield course will combine virtual online training and face-to-face meetings, matching the design of the Dartmouth course. This first cycle of training will include Sheffield's future microsystem coach trainers. The second cycle of the course will be delivered by Sheffield trainers with oversight and visits by Dartmouth staff. To support this programme, the team will use IT support methods such as social networking and SharePoint. This will enable access to fully translated materials and provide a framework for outcome measures, reflection and peer support.

Evaluation approach
The evaluation framework is based on a theory of change approach linked to the logic model of programme planning and evaluation. This approach allows for systematic evaluation of the links between inputs, activities, outcomes and the context of the initiative:

Context 
The MCA is being established in a dynamic healthcare context. Changes in the context at macro (healthcare system), meso (organisation) and micro (system) level are likely to influence the success of the MCA. Observation of any changes which impact upon the MCA for the duration of the project will be monitored. This will include consideration of the influence of context on the initiation, implementation, sustainability and extension of the MCA and associated activity.

Process
The extent to which the MCA initiative is implemented as intended will be measured, identifying changes that occur over time. The innovative nature of the initiative means that initial intentions are likely to be adapted as the Academy gets underway and the MCA teams learn from their experiences. Identifying the extent of change, the reasons why change occurs and the impact that change has on the overall objective of the initiative will be examined. Five areas will be examined in detail: inputs, activities, participation, satisfaction and the role of the MCA core team.

Outcomes and impact
The short, medium and longer term outcomes and the impact that these have on individual participants, the organisation (micro and meso context) and the wider healthcare economy (macro context) are important to judging the overall success of the MCA. Consideration will be given to the extent to which the intended goals are being met, who is benefiting and how, together with what appears to work well or not. Unintended consequences of the MCA initiative will also be monitored.

Overall short-term outcomes will focus on changes in the capability of participants (knowledge & skills), participant motivation and engagement in quality improvement activities as a result of the Coach in Training (CIT) microsystem activity.

Data Collection
A range of quantitative and qualitative methods of data collection will be used to answer these questions:

Individual coach assessment of knowledge and skills acquisition by use of a pre/mid and post measure questionnaire

• Microsystem assessment of coaching effectiveness
• Focus groups with trainers
• Focus groups with coaches
• In-depth case studies of individual coach development
• Field notes of observation of microsystems coaching
• Questionnaire to assess motivation and engagement in quality improvement Data collected by MCA as part of CIT and microsystems activity will be integrated with data collected by the evaluation team.

Findings from formative evaluation will be fed back to the MCA core team and key stakeholders at significant points during the initiative, in particular upon completion of each coach in training (CIT) programme.

The summative evaluation will focus on the impact of implementing the MCA within STH and SCH, and the extent to which it achieves the aim of an organisational wide focus on quality improvement. Findings from the summative component will provide an overall evaluation of the initiative and key lessons learnt upon completion.
The evaluation team will work with the MCA core team and other key stakeholders involved in the initiative to populate the logic model framework by identifying activities to be implemented, intended outcomes, resources and contextual factors that may impact on the implementation of the MCA.

For further information about the Microsystems Coaching Academy, please see here