CEREBRAL PALSY IMPROVEMENT WORK PLEASES PATIENTS The ‘Botox for Children with Cerebral Palsy’ team administer Botox™ injections to children with cerebral palsy and other neuromuscular conditions during surgery under general anaesthetic at Sheffield Children’s Hospital. Following the procedure, patients should receive prompt physiotherapy to maximise the benefits of the treatment. The team called upon the Sheffield Microsystem Coaching Academy for support in improving the effectiveness of their processes, and Emma Smith began coaching the team in May 2013. At first, some members of the team were sceptical that a coach would be able to improve the clinical effectiveness of their work – but in less than five months, the number of patients receiving physiotherapy within 15 days of Botox™ surgery had increased from 52% to 92%. Our purpose: To provide a seamless, equitable service that is well-integrated for children with cerebral palsy receiving Botox™ to help improve their quality of life. appointment, often long after the treatment had been administered. This lack of clear communication resulted in the Botox™ injections being redundant, and it became clear that this error was not uncommon. One parent said “Without clear communication the treatment is pointless, and puts my child through unnecessary anaesthesia with zero benefit.” At their fortnightly microsystem team meeting, the team acknowledged that communication was the key issue within the team and sought to improve this in order to ensure the patients received timely and effective therapy input. As part of the assessment phase of the improvement process, the team were encouraged by Emma to invite a parent of a patient to be part of their improvement group to ensure the changes they made were going to benefit the patient. The parents informed the team that physiotherapists often only heard of the child receiving Botox™ during a regular therapy
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CEREBRAL PALSY IMPROVEMENT WORK PLEASES PATIENTS · The ‘Botox for Children with Cerebral Palsy’ team administer Botox™ injections to children with cerebral palsy and other
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CEREBRAL PALSY IMPROVEMENT
WORK PLEASES PATIENTS The ‘Botox for Children with Cerebral Palsy’
team administer Botox™ injections to
children with cerebral palsy and other
neuromuscular conditions during surgery
under general anaesthetic at Sheffield
Children’s Hospital. Following the procedure,
patients should receive prompt
physiotherapy to maximise the benefits of
the treatment.
The team called upon the Sheffield Microsystem
Coaching Academy for support in improving the
effectiveness of their processes, and Emma Smith
began coaching the team in May 2013. At first,
some members of the team were sceptical that a
coach would be able to improve the clinical
effectiveness of their work – but in less than five
months, the number of patients receiving
physiotherapy within 15 days of Botox™ surgery
had increased from 52% to 92%.
Our purpose:
To provide a seamless, equitable service
that is well-integrated for children with
cerebral palsy receiving Botox™ to help
improve their quality of life.
appointment, often long after the treatment had
been administered. This lack of clear
communication resulted in the Botox™ injections
being redundant, and it became clear that this error
was not uncommon. One parent said “Without
clear communication the treatment is pointless, and
puts my child through unnecessary anaesthesia with
zero benefit.” At their fortnightly microsystem
team meeting, the team acknowledged that
communication was the key issue within the team
and sought to improve this in order to ensure the
patients received timely and effective therapy input.
As part of the assessment phase of the improvement process, the team
were encouraged by Emma to invite a parent of a patient to be part of
their improvement group to ensure the changes they made were going to
benefit the patient. The parents informed the team that physiotherapists
often only heard of the child receiving Botox™ during a regular therapy
The team identified clear bottle necks and points for concern though
tools such as process mapping. This identified a number of changes
required to the patient pathway which would make a considerable
improvement towards the goal of every patient having timely access to
physiotherapy after receiving Botox™.
This improvement process highlighted to consultants and therapists the
benefits and importance of therapy, and the impact on patients and their
families when poor communication reduces clinical effectiveness. The
microsystem improvement work has given insight into things that the
team didn’t even realise were issues, such as the lack of an information
booklet for patients on what to expect following the Botox™ treatment.
The work has helped the team work more closely together, understand
the different departments involved in the process and the impact they
have on the pathway. This process has been helpful for removing the
barriers between the different professionals within the multidisciplinary
team.
The team have really valued having an improvement coach to support them. Physiotherapist Helen noted that she
“wanted to make improvements, but didn’t know how”, and that coaching has given her the forum to improve the
system for patients. Comments from other departments and professionals outside the lead improvement team have
been positive, with one colleague expressing that “it’s great to see different members of the team working together.”