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