Quality Improvement

Quality Improvement

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The ED Team Coaching programme, ‘e-coach the coach’ (eCTC) commenced in June 2013 and involves nurses and doctors from EDs across Ireland. It is an intensive, dynamic and highly interactive experiential learning series blending electronic and face-to-face formats to develop coaching knowledge, skills, and abilities. Originating from decades of experience achieved by the Dartmouth Institute Microsystem Academy in the field of coaching interdisciplinary healthcare groups and advanced through cutting-edge research specific to coaching interdisciplinary groups to engage in healthcare improvement, eCTC has documented improved outcomes in healthcare improvement around the world.

This training programme has been made possible through a collaboration between the EMP, the National Leadership and Innovation Centre for Nursing and Midwifery of the Office for Nursing and Midwifery Services Director, HSE and the Dartmouth Institute Microsystem Academy, USA.

The Clinical Microsystem approach places the patient-clinician interaction at the centre of all quality improvement activity and is adaptable to the unique context of each ED. Front-line ED staff are trained to become quality improvement coaches leading local improvement teams to assess, diagnose and treat their EDs to provide better patient care.

Resources for Quality Improvement

Central to the programme is the “Team Coaching Model” with three phases of coaching activities – pre-phase, action phase and transition phase. This coaching model is unique and specific to groups of interdisciplinary healthcare professionals interested in making improvements in healthcare.

The overall aim of the programme is to improve value, safety and quality of healthcare outcomes through development of coaching knowledge, skills and abilities to coach frontline interdisciplinary clinical and supporting microsystems with knowledge, processes, and tools including the Dartmouth Microsystem Improvement Curriculum (DMIC).

Participants of this programme are developing:

  • Knowledge and skills in clinical microsystem fundamentals.
  • Knowledge, skills and abilities in the art and science of coaching interdisciplinary healthcare groups to engage in healthcare improvement and improve group dynamics.
  • A coaching plan for personal and professional development in coaching front-line groups in healthcare improvement to result in improved outcomes for patients, families, staff and organizations.


The Clinical Microsystem approach is one that every ED clinician will recognise – Assessing, Diagnosing and Treating your ED. The approach involves five steps:

  1. Organise a lead team to drive and coordinate improvement;
  2. ‘Make an Assessment’ of your ED using the 5 ‘Ps’ (Purpose, Patients, Professionals, Processes, Patterns) and Metrics that Matter;
  3. ‘Make a Diagnosis’ and identify areas for improvement;
  4. Plan and commence improvement – ‘Treat your ED’; this step encompasses complimentary improvement methods including Lean improvement tools;
  5. Follow-up and evaluate in a continuous improvement cycle that is embedded in the day-to-day work of your ED.


For further information on the Ireland Emergency Department Clinical Microsystem Improvement Coach Training Programme please contact emp@rcsi.ie.