Abstract
To identify learning from a clinical microsystems (CMS) quality improvement initiative to develop a more integrated service across a falls care pathway spanning community and hospital services. Falls present a major challenge to healthcare providers internationally as populations age. A review of the falls care pathway in Sheffield, United Kingdom, identified that pathway implementation was constrained by inconsistent co-ordination and integration at the hospital-community interface. The initiative utilised the CMS quality improvement approach and comprised three phases. Phase 1 focussed on developing a climate for change through engaging stakeholders across the existing pathway and coaching frontline teams operating as microsystems in quality improvement. Phase 2 involved initiating change by working at the mesosystem level to identify priorities for improvement and undertake tests of change. Phase 3 engaged decision makers at the macrosystem level from across the wider pathway in achieving change identified in earlier phases of the initiative. The initiative was successful in delivering change in relation to key aspects of the pathway, engaging frontline staff and decision makers from different services within the pathway, and in building quality improvement capability within the workforce. Viewing the pathway as a series of interrelated CMS enabled stakeholders to understand the complex nature of the pathway and to target key areas for change. Particular challenges encountered arose from organisational reconfiguration and cross-boundary working. CMS quality improvement methodology may be a useful approach to promoting integration across a care pathway. Using a CMS approach contributed towards clinical and professional integration of some aspects of the service. Recognition of the pathway operating at meso- and macrosystem levels fostered wider stakeholder engagement with the potential of improving integration of care across a range of health and care providers involved in the pathway.
Highlights
This development paper reports on the learning to arise from an innovative approach to developing an integrated falls pathway across community and acute services using the clinical microsystems (CMS) methodology developed by the Dartmouth Institute, USA
The aim of this paper is to report on the learning to arise from using the CMS approach to promote integrated care across the falls care pathway
Using a CMS quality improvement approach enabled the engagement of frontline staff from different components of the pathways and contributed towards clinical and professional integration of some aspects of the service
Summary
This development paper reports on the learning to arise from an innovative approach to developing an integrated falls pathway across community and acute services using the clinical microsystems (CMS) methodology developed by the Dartmouth Institute, USA. The initiative was a partnership with Sheffield Teaching Hospitals NHS Foundation Trust, which encompasses acute and community services in the city, and other service providers involved in the falls pathway. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health and Research and Care (CLAHRC) for South Yorkshire worked with the project team to capture the learning arising from the initiative. In the United Kingdom, people aged 65 and older are at most risk of falling, with a third of people older than 65 years and half of people older than 80 years falling at least once per year [National Institute for Health and Care Excellence (NICE), 2013]. The wider costs to society are likely to be far greater
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
