For nearly 20 years, IEHSS has worked with the Cystic Fibrosis Foundation to decrease practice variation in the systems and processes of lung transplant referrals and transitions from cystic fibrosis (CF) programs to transplant programs. Using a wave model, interprofessional Lung Transplant Transition Learning and Leadership Collaboratives (LTT LLCs) are developed and coached through a customized Microsystem Improvement Process (MIP) and leadership development program for 18 months. LTT LLCs then join the Regional Dissemination Network (RDN) for 12-18 months to develop and disseminate best practice recommendations. The programs then reach a stage of continuous improvement to sustain achievements in patient care.
The work continues today and over 90% of CF centers participating and multiple process improvements closely linked to the impact of CF LTT LLC, including:
38 organizations and 80 improvement coaches engaged in strategies for change that included:
Using the Dartmouth Microsystem Improvement Curriculum (now the Microsystem Improvement Process), the Plastic Surgery Section has seen improvement in patient and staff satisfaction, access to care and clinical productivity. It has become the leading clinical program for achieving productivity rates exceeding national benchmarks (Nelson, Batalden, Godfrey, 2007). Read more in Quality by Design: A Clinical Microsystems Approach by Eugene C. Nelson, Paul B. Batalden and Marjorie M. Godfrey.
Our team supported the creation of the Microsystem Coaching Academy in the UK as part of Sheffield Teaching Hospitals, part of the National Health Service Foundation Trust. To date, the academy has trained 273 microsystem coaches and taught over 1,400 staff in “Introduction to Quality Improvement” courses.
32 professionals from seven agencies participated in 18 electronic learning sessions to build community partnerships to advance health promotion for seriously mentally ill clients.
“Using the team coaching model in my leadership role has changed the whole unit where I am a manager. Staff now regularly offer solutions, ideas and have better communication and relationships. Patients and families are included and eager to help.”
“I now have more confidence to leave my home. I used to be afraid to leave my home and would sit there all day. I enjoy meeting new friends at the gym and my health mentor has helped me lose 15 pounds.”
“We have been doing QI (quality improvement) work for years but this is far and away the best QI momentum that we’ve ever had.”
“The improvements in research and care in CF in the past 20 years have been nothing short of extraordinary, and today’s announcement of the increase in population of people living with CF is a testament to that.”
"Rounding twice a day has led to the development of an “escalation” pathway for issues and fewer interruptions."
“...the clinic nurses … got pulled in a room for 30 minutes, and turns out that they're already explaining 50% of what the physician already explained… So, it's kind of like, "What can we do to help make your job easier?" And that … draws in a little bit more of, "Okay, maybe I do want to work with this (quality improvement), and get this to work, because it makes my job easier."
"And I think working with the transplant, […] hospital as well has helped us […] as a group, to try to figure out any missing pieces that we might, […] need to make sure that we […] communicate to the families, and the patients […]. I think that's so important, keeping that communication link open, because sometimes, […] you send them off, and it's like you don't [hear] anything. And I think a lot when you keep that continual communication going, […] it will benefit the family, […] to keep that going. And that's what we've been able to try to work on as well."