Galway & Roscommon University Hospitals Group

1. Portiuncula Hospital Ballinasloe Roscommon County Hospital
National Healthcare Conference
20 March 2013
th
Bill Maher, Group CEO

4. “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.”

5.  Where have we come from?
 Where are we now?
 Where next?

6.  Greater efficiency
 Growing demand
 Growing expectation
 Growing complexity
 Organisational reform
 Growing accountability
14

7.  DOH Statement of Strategy 2011-2014
 Future Health, 2012-2015
 Transition from the HSE
 HIQA Tallaght Report
 HIQA Standards
 Establishing the foundations for Trusts

8. 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

11.  Groups of hospitals
 National Clinical Programmes
 Local accountability/empowerment
 National Standards
 Results driven
 Money follows patient

12.  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

13. 3

14.  Proud to be at the heart of change
 Unique opportunity
 Proud to be test pilots for reform
 Aim to deliver on our promises

15. Developing IT Solutions
Implementing Clinical Programmes
Improving Access
Developing Financial Control
Building Capacity
Establishing Performance Management
Establishing sound Governance
Establishing a clear vision and HLWP

16.  Group Governance Structure
To establish sound  Clinical Directorate Structure - at the heart
Corporate & Clinical
Governance Model to
integrate the Group  Group Integration
 Executive Council
 Board of Directors

17. Board Committees
Board of Directors 1.Finance
2.Audit
CEO 3.Quality & Patient
Safety
Group Executive Council
(Chair CEO)
Group Management Nursing Professional Clinical Directors
Team Council Forum
( Chair COO) ( Chair GDON) (Chair Group CD)

19.  A job not a title
 Engaged and empowered
 Need to develop tools to support
 Need to equip the team

20.  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

21.  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

23. ◘ Noel Daly appointed as Chair
◘ Terms of Reference/Committee Structures established
◘ 4 July Inaugural Board Meeting
th
◘ Appointment of Non-Executive Directors
 Complementary skills
 Local champions
 Running the “business”
 Remembering it’s a service

25. Admission Rates Throughput
ED Admission Avoidance
N:R ratio Nurse lead activity
To increase capacity Outpatients
DNA rate Productivity
through efficiency
Waiting Times Diagnostics Availability
Unnecessary tests
Readmission Rates Day Case Rates
Inpatients
Length of Stay DOSA
Delayed Discharges
1. Undertake for each Directorate
2. Create Clinical Champions
3. Establish Governance

26. ◘ Developed Performance Management Culture
To develop Performance ◘ Agreed KPI set for each Hospital
Management Framework to
drive performance
improvement & accountability ◘ Agreed KPI set for each Directorate
◘ Reporting Systems in place
◘ Key part of Communication Strategy
◘ Empower people and make them accountable

28.  Establishment of Group Finance Committee
 Production of individual CCP for each Hospital
 Engagement/Ownership by Clinical Directors in CCP
To establish a framework for
Financial Control and  Established Income Focus Committees/Cost Control
delivery of
Cost Containment Plans 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

29.  Inpatient Waiting List
To meet national access
targets and restore
 Outpatient Waiting List
Galway’s reputation as a
leading hospital
 Trolley Waits in ED
 Diagnostic Waiting Times

30.  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

32. Patients have been treated in all
Group hospitals
Roscommon: Portiuncula:
•GI Scopes
•Plastic Surgery
Patients from the GUH PTL were treated in the •GI Scopes
•Urology following locations: •Urology
•General surgery
•General surgery
•Maxillofacial Surgery
•Sleep studies
Merlin Park: UHG:
•Orthopaedics • All specialties, with
•Pain particular focus on complex
•Medical Interventions procedures

33.  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

34.  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

36. AMU Pt Flow Cohorting CMN Bed
24/7 Meet 7.45am SSU
Meeting

37. 2011
2012

38. ◘ National Clinical Programmes Steering Group
in place
To adopt best practice and ◘ Re-engagement with National Clinical Programmes
develop patient pathways to
improve quality & efficiency ◘ 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

39.  Benchmarking – CIMS
 Understanding our cost base – ABC
To develop IT to support  Reducing storage cost and improving record
patient care and improve
efficiency 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

40.  Group ‘born’ on 9 January, 2012
th
 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