Post on 11-Nov-2014
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National Healthcare Conference 20th March 2013
Bill Maher, Group CEO
Roscommon County HospitalPortiuncula Hospital Ballinasloe
“It ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.”
Where have we come from?
Where are we now?
Where next?
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Greater efficiency Growing demand Growing expectation Growing complexity Organisational reform Growing accountability
DOH Statement of Strategy 2011-2014
Future Health, 2012-2015
Transition from the HSE
HIQA Tallaght Report
HIQA Standards
Establishing the foundations for Trusts
Hospital Hospital Level Beds Staff
University Hospital Galway 4 542 2500
Merlin Park Hospital 2 66 517
Roscommon Hospital 2 63 278
Portiuncula Hospital 3 158 644
Groups of hospitals National Clinical Programmes Local accountability/empowerment National Standards Results driven Money follows patient
Governance & Leadership Implementation of Clinical Director Structures Group Integration Establishing the Board Development of Performance Management Culture Human Resource Challenges (Retirements, Ceiling,
Absenteeism) Financial Challenge 2012 €35m Access Targets (Trolley Waits, Waiting Lists) Implementation of National Clinical Programmes
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Proud to be at the heart of change Unique opportunity Proud to be test pilots for reform Aim to deliver on our promises
Implementing Clinical Programmes
Improving Access
Establishing a clear vision and HLWP
Establishing Performance Management
Establishing sound Governance
Building Capacity
Developing Financial Control
Developing IT Solutions
Group Governance Structure
Clinical Directorate Structure - at the heart
Group Integration
Executive Council
Board of Directors
To establish sound Corporate & Clinical Governance Model to integrate the Group
Board of Directors
Group Executive Council (Chair CEO)
Group Management Team
( Chair COO)
Clinical Directors Forum
(Chair Group CD)
CEO
Nursing Professional Council
( Chair GDON)
Board Committees1.Finance2.Audit3.Quality & Patient Safety
A job not a title Engaged and empowered Need to develop tools to support Need to equip the team
Clarified role of each Hospital Implementation of National Model of Care Level 4, 3
& 2 Developing one Strategy / Vision for the Group Creating “Model Hospitals” Creating a sense of team through Clinical
Directorates
Key Decision Making Group Meets monthly Informed by:
- CD Reports- GM Reports- Finance Reports- HR Reports- Nursing Reports
Oversees:- Delivery of KPIs- Delivery of Cost Containment Plans- Quality & Safety- Priorities
◘ Noel Daly appointed as Chair ◘ Terms of Reference/Committee Structures
established ◘ 4th July Inaugural Board Meeting ◘ Appointment of Non-Executive Directors
Complementary skills Local champions Running the “business” Remembering it’s a service
1. Undertake for each Directorate2. Create Clinical Champions
3. Establish Governance
Admission Avoidance
Throughput
Length of Stay
Admission Rates
Readmission Rates
Waiting Times
ED
Outpatients
Diagnostics
Inpatients
N:R ratio
Day Case Rates
Availability
DOSA
Delayed Discharges
Nurse lead activity
DNA rate
Unnecessary tests
ProductivityTo increase capacity through efficiency
◘ Developed Performance Management Culture ◘ Agreed KPI set for each Hospital
◘ Agreed KPI set for each Directorate
◘ Reporting Systems in place
◘ Key part of Communication Strategy
◘ Empower people and make them accountable
To develop Performance Management Framework to
drive performance improvement & accountability
Establishment of Group Finance Committee
Production of individual CCP for each Hospital
Engagement/Ownership by Clinical Directors in CCP
Established Income Focus Committees/Cost Control
Committees in each Hospital
Detailed Budget Monitoring Reporting on monthly basis
Established Employment Control Committee
Financial Reporting to Group Management Team, Group
Executive Council
Established set of Financial KPIs for Group and each
Hospital
To establish a framework for Financial Control and
delivery of Cost Containment Plans
Inpatient Waiting List
Outpatient Waiting List
Trolley Waits in ED
Diagnostic Waiting Times
To meet national access targets and restore
Galway’s reputation as a leading hospital
Reduction in Inpatient Waiting List from 9,901 to 0
SDU Steering Group
9 Month PTL - 5 Point Plan Increased focus on validation Improved reporting ownership Effective use of all resources across Group hospitals Patient education and engagement Effective Use of Theatre space
Celebrated our success
Patients have been treated in all Group hospitals
Patients from the GUH PTL were treated in the following locations:
Roscommon:
•GI Scopes•Plastic Surgery
•Urology•General surgery•Sleep studies
Merlin Park:•Orthopaedics
•Pain•Medical Interventions
Portiuncula:•GI Scopes•Urology
•General surgery•Maxillofacial Surgery
UHG:• All specialties, with particular focus on
complex procedures
Major challenge for the organisation
Progress to date High Level Action Plan developed to address key areas Five Point Action Plan now in place to focus on initiatives such
as converting review capacity to new capacity Ongoing Validation – established Call Centre & wrote to 20,000
patients great than 12 months, with a 42% removal rate Reducing DNA rate to target areas with long waiters
Comprehensive Bed Modelling Exercise using an in-house developed tool and supported by some of the work by Dr. Orlaith O’Reilly
Re-allocation of 25 surgery beds to medicine based on bed modelling exercise, to better reflect the actual demand for services
Development of a comprehensive bed protection policy supported by Clinical Directors
Development of the escalation policy & full capacity protocol for times of exceptional activity
Appointment of a dedicated Patient Flow Coordinator for both Medicine and Surgery Appointment of a dedicated Discharge Coordinator Establishment of a Patient Flow Team with input from Nursing, Social Work, AHPs,
Consultant and Management-Meeting 3 times a day at 8am (previously 9.30am) 12pm & 3pm
Full opening of the Acute Medicine Unit on 24/7 basis (previously Mon-Fri 8 a.m.– 8 p.m.)
Opening of a 32-bedded Medical Short Stay Unit (48hrs) - within existing resources Development of specialty specific bed compliments within Medicine and Surgery
Pt Flow Meet 7.45am
AMU 24/7
Cohorting CMN Bed Meeting
SSU
2011
2012
◘ National Clinical Programmes Steering Group in place
◘ Re-engagement with National Clinical Programmes
◘ National Team Site Visits relating to 20 programmes to date
◘ Acute Medicine, Heart Failure, Epilepsy, Diabetes Foot Care, Elective Surgery & Anaesthesia all commenced
◘ Roll out of COPD, ACS, Asthma, Emergency Medicine and Palliative Care
To adopt best practice and develop patient pathways to improve quality & efficiency
Benchmarking – CIMS Understanding our cost base – ABC Reducing storage cost and improving
record keeping – Document Management Strategy
Improving quality systems & incident management – QPulse
Reducing Length of Stay, improving patient flow – Bed Management System
Theatre efficiency – Theatre Management System
Patient Involvement - PROMS
To develop IT to support patient care and improve
efficiency
Group ‘born’ on 9th January, 2012 Established Corporate & Clinical Governance arrangements Developed Clinical Director Structure and support
mechanisms Reduced Inpatient Waiting List from 9,901 to 0 Decreased trolley waits despite significant increase in ED
admissions Developed Performance Management culture / KPI sets Integrated services within the Group Operating under WTE Ceiling / Reduced Absenteeism Re-engagement with National Clinical Programmes Delivering more activity with reduced spend Board now established