The key issues to be addressed in HSE reconfiguration

While there is agreement on how major acute work should be carried out we now need to examine how and where the rest of patient care and treatment should be delivered, Brian Gilroy, HSE National Director of Reconfiguration told the HMI Forum.  Maureen Browne reports.

The HSE’s reconfiguration programme was not a process for closing down rural or secondary hospitals, its objective was to improve the quality of care, access to care and patient throughput, Mr. Brian Gilroy, HSE National Director of Reconfiguration told the HMI Forum in Tullamore, Co. Offaly.

Brian Gilroy
Brian Gilroy

There were a number of key issues which needed to be addressed in the reconfiguration.  One was whether you could have medicine without surgery in hospitals and another was to differentiate between the needs of patients with end care chronic illness and those suffering from acute trauma.

“We know that, if necessary, people should travel long distances for major acute work where all the evidence is that you need high volumes to maintain expertise.  In this regard, I would prefer doctors to tell patients what is safe rather that having it done by somebody like me or by politicians.

The HSE’s reconfiguration programme is not a process for closing down rural or secondary hospitals

“I think there is agreement on how major acute work should be carried out and what we need to examine now is how and where the rest of patient care and treatment should be delivered.”

He detailed how the reconfiguration programme was going to be rolled out to the region and the processes by which they would be approved, managed, implemented and monitored.

Consistency of approach

The HSE was going through a process to ensure that there was consistency of approach to enable the reconfiguration programme to be delivered on a national basis.

At present work was very surgically centred as it seemed the safety of surgery was a driver behind much of the reconfiguration programme to date.    Clinical safety issues were the same throughout the country.   “If you can’t do something in one part of the country, you can’t do it in another part.”

“If you can’t do something in one part of the country, you can’t do it in another part”

Gilroy, who is also HSE National Director of Commercial & Support Services & Ambulance Services, said that a reconfiguration protocol which would set out the arrangements for regional reconfiguration planning, approval, implementation and monitoring of progress was being finalised at present and would be signed off shortly.

In the Mid West reconfiguration there was some confusion as to who was responsible for what.  The protocols would give clarity to this.

The protocol would also incorporate clinical assessment of alignment of plans with findings and recommendations from HSE commissioned national and regional reviews to ensure that there was consistency, where appropriate, across local implementation actions.

Detailed action plans

The regions would build from the ground up.  The protocol would be used to ensure that all proposals from the regions would go through the regional reconfiguration exercises, be endorsed at RDO level and submitted for approval to himself, as National Director ISD Reconfiguration.

All such proposals would also be subject to review and approval by the National Director of Quality & Clinical Care, Dr. Barry White, to ensure that they aligned with the emerging work from the QCC programmes.

Regional configuration actions to take place this year would be set out in detailed action plans.

These RDO action plans would be agreed with the National Director of ISD Reconfiguration and with the National Director of QCC and would form part of each region’s performance contract.

He said governance was required for each phase of the reconfiguration project and for the movement from one phase to the next.

Key project management deliverables would be produced at the end of each stage

In order to move from one phase to the next, evaluation and sign off of the key milestones must take place through agreed management and decision making processes.

Performance review process

This would be monitored through regional and national performance review process on a quarterly basis.

There will also be a standard approach adopted for the management of projects within the reconfiguration programme.

The underlying principle, in line with best practice for the management of projects, was that all projects would be managed on a four stage basis – initiation, planning, implementation and closeout – with checkpoints agreed in advance in place at the end of each stage.   Key project management deliverables would be produced at the end of each stage.

A standard project management pack with information and generic templates for use in the management of the projects had been issued to each region and training programmes would be arranged for staff in the regions who were responsible for managing these projects.

Appropriate governance arrangements would:

  • Outline the relationship between all internal and external groups involved in the project
  • Describe the proper flow of information regarding the project to all stakeholders
  • Ensure that appropriate review of issues encountered with each project
  • Ensure that required approvals and direction is obtained at each appropriate stage of the project

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