How the SDU will work

The new health information systems developed by the Department of Health Special Delivery Unit will enable hospitals to identify at the touch of a button, patients on long waiting lists, the consultant to whom they have been referred and the procedures for which they are waiting, Dr. Martin Connor, the head of the SDU, told the HMI Annual Conference.

Martin Connor
Dr. Martin Connor, Head of the SDU

Speaking on “Driving Special Delivery Unit Improvements: the Manager’s Role and Tools for Success,” he said that having this type of information available in real time would make all the difference to how these patients were managed.   We will no longer be managing by exhortation, we are not saying ‘do more,’ we are saying ‘do it right’ so that we can deal with the patients who have been waiting longer than target times.

“When hospitals have this information, they can then look at alternative methods of having these patients treated – it might be possible to split them between members of the team or make arrangements to have them treated elsewhere.”

He said that in some ways we had to create a system we didn’t have – how to organise and co-ordinate care and manage institutional care to deliver it. While he was increasingly confident we could get the framework for this established, it would take about three years to put in place actual improvements for patients.

The system will show up every emergency admission from the previous day, show the time at which they arrived and the contributions on the different stages of their clinical journey

“What would it be like if almost everything we know about health care was completely wrong?  Whenever we lack information, we create myths and try to survive from Monday to Friday by trading these stories to comfort ourselves and help us believe that the work we are doing is of value.

“Instead we need an information rich society with facts.  We need to make different type of decisions. I am describing some of the foundation pieces here today, but I think the end game is multidisciplinary teams at all levels and we all know that won’t be happening tomorrow or next week.

“The information system will show up every emergency admission from the previous day, the time at which they arrived and the contributions on the different stages of their clinical journey.  This will be a very valuable resource to enable people in the hospital to see how the system is working.”

Whenever we lack information, we create myths and try to survive from Monday to Friday by trading these stories to comfort ourselves and help us believe that the work we are doing is of value

Patients will not be identified, but clinicians will be able to see their MRN and doctors will only be identifiable within their hospital. As well as in-patients and day cases, there will also be daily charts for Emergency Departments.

Connor said we needed to establish systematic and comprehensive weekly monitoring systems.  We also needed to clarify sanctions and incentives.  In Sweden, for example, charged community services were charged so much an hour for delayed discharges.  He was not necessarily advocating doing that but it reflected thinking on this area.

“We need to hold leaders personally accountable for performing against KPIs and push decisions down to the lowest possible levels.

“There are seven to eight people in the core SDU team.  The SDU and the clinical programmes are two sides of the same coin.  We intend to bring executive discipline to support the vision laid out in the clinical programmes, particularly in acute medicine, as it relates to trolleys waits and emergency care and as it relates to electives.

“We are working very hard with other parts of the HSE and the NTPF to try and engineer a different focus on the management of scheduled care.  The SDU exists to absolutely support HSE Performance Management, through existing processes.

“The values for the healthcare transformation – which will be delivered through the clinical programmes – are that they are accountable, quality based, information rich and professionally led.

We need to prevent a situation where the same problems rattle round in some organisations indefinitely, without any agreed method of resolving them

“We need to establish (these are suggestions, not policy at this stage, but I think we need to move towards them) that you can’t leave risks alone out in the system without naming them, quantifying them and using agreed ways to sort them out.   We need to prevent a situation where the same problems rattle round in some organisations indefinitely, without any agreed method of resolving them.

“We must avoid allocating too much risk to our patients. Overcrowding in EDs reduces outcomes and in some cases increases mortality and that is something we need to resolve.

“We have to construct an accountability framework – who is in charge, who is responsible, have they the powers and responsibility which are necessary and are they appropriately supported?

“One of the things which I am thinking of at present is a hospital score card, changing some of the thresholds and creating new accountability frameworks which need to focus on safe high quality patient centred service, in an unprecedented financial environment.

“In order to do this, we have to know where we are going and map out on a multi year basis, the type of approach we are gong to take. We need to set three year targets, describe the pace of change in EDs, day cases, outpatients and diagnostics.

“Each of our sites has a range of variations which will happen anyway, so we need to figure out how we need to manage between 700 and 900 attendances a day, rather than 800 a day which we will probably never get. This is quite a different approach. Similarly for emergency admissions per week.  Our bed stocks are generally fixed and we need to figure out how to set up our bed capacity to be more flexible.  The way we organise our medical and surgical allocations is an integral part of this.”

Connor said that the very short term work of the SDU included  preparing EDs for a shift to total journey times, ISA based capacity planning for winter, starting weekly performance meeting, establishing discharge/bed management networks, signing off on local capacity plans and signing off on escalation plans.

We needed to know if each hospital had sufficient capacity to manage on a busy day and if it was set up to handle variation levels. “We need a brutally honest conversation about capacity – we must understand exactly the impact of length of stay on overall demands. It should also be possible to plot times when high levels of attendances could be expected at EDs- for example when GPs were closed, the first day after  five days closed  and identify in advance times of major fluctuation.  It was then necessary to co-ordinate the whole.

Connor said that we needed to professionalise the strategic management of hospital networks.

In reply to a question from Fintan Fagan, Chief Operations Officer at the Mater Private Hospital in Dublin, on his plans to engage with the private and independent sector, he said this was under developed at the moment.  He saw a sustainable role for the private sector.  The question was how we managed it.