Hospital Group is master of its own destiny

Health Minister, Dr. James Reilly, has allowed the new Galway/Roscommon Group of hospitals be master of its own destiny, according to Mr. Bill Maher, CEO of the Group. Maureen Browne reports.

Health Minister, Dr. James Reilly, has allowed the new Galway/Roscommon Group of hospitals be master of its own destiny, according to Mr. Bill Maher, CEO of the Group.

He said the Group was proud to be at the heart of change and aimed to deliver on its promises.

He said that one of the results was that in the first 270 days of this year, the Group had reduced trolley waits, treated the 9,901 patients, who at the start of the year had been more than nine months on the waiting list, and would have significantly reduced spending whilst considerably over-performing on activity targets.

The “new hospital model” – and the Galway/Roscommon University Group was a pilot at the forefront for this reform – would be based on groups of hospitals, national clinical programmes, local accountability/empowerment, national standards and would be results driven, with money following the patient.

“We have excellent clinical leaders and when I took up my post last January, my job was to help them work and to really tap into the reserves of good will, to put governance arrangements in place and to try and join the hospitals together.”

He said the key challenges for 2012 were governance and leadership, implementation of the Clinical Director structures, meeting access targets for trolley waits and waiting lists and implementing the national Clinical Programmes.

“Galway had been kept in check by lack of clarity about who could make decisions that mattered. We had service pressures with scheduled and unscheduled care, falling staff numbers and a notional budget while we were expected to achieve targets and clear waiting lists.

Galway had been kept in check by lack of clarity about who could make decisions that mattered.

Our hope was that the Group would be empowered, there would be accountability, quality standards and results, that it would be outcome driven with the hope of activity being rewarded.

It was necessary to integrate the Group, establish a Board, and develop a performance management culture, deal with the human resource challenges (retirements, the employment ceiling, and absenteeism) and the financial challenge.”

The corporate clinical governance structure consisted of a Board of Directors (with Finance, Audit and Patient Safety Committees), a CEO, a Group Executive Council (chaired by the CEO), a Group Management Team (chaired by the Chief Operations Officer), a Cancer Strategy Group and a Clinical Directors Forum (chaired by the Medical Director).

Committees for Group ICT, Estates, Employment Control and HR reported into the Group Management Team and the Clinical Programme Steering Group and the Clinical Directorates Committee reported into the Clinical Directors Forum. The Surgical, Medical, Laboratory, Womens & Childrens, and Theatre and Critical Care Directorates reported into the Clinical Programme Steering Group and the Clinical Directorates Committee.

The Clinical Directorate structure provided for management accountant, HR, Business Manager, senior nursing and administrative support, specialty leads and an Allied Health Professional  rep, who reported to the Clinical Director who reported to the Executive Council.

Mr. Maher said that Clinical Directorates  had to be engaged and empowered, tools to support them needed to be developed, the team needed to be equipped, people needed to trust each other, the role of each hospital in the Group had to be clarified, the National Model of Care at the different levels had to be implemented, one strategy/vision had to be developed for the Group and the “model hospitals” had to be created.

“We had to run a business, remembering it was a service. We agreed a KPI set for each hospital and for each Directorate, put reporting in place, empowered people and made them accountable and developed a performance management culture.”

Mr. Maher said that between 2008 and 2011, net expenditure for the Group had been reduced by €46 million or 12 per cent, while inpatient and day cases had increased by 6,187 or five per cent. The financial challenge faced by the Group for 2012 was a carry- forward of a 2011 overrun of €23 million and a budget reduction of €12 million – a total challenge of €35 million.

I want hospitals to appreciate that this is not downgrading but an opportunity to allow them to develop services of which their locality will be proud.

Major cost containment measures implemented included reducing on-call by €600,000, reducing overtime by €600,000, reducing agency by €1,500,000 while income was increased by €2,400,000.  The forecasted position for the end of 2012 was that the Group would break even for this year, although they hadn’t tackled the historic €24 million debt.

On the HR side, they had developed a Group HR structure, managed the February retirements, brought their WTEs to underneath the ceiling and reduced absenteeism from 5.2 per cent to 4.3 per cent

They had reduced the inpatient waiting list from 9,901 to zero waiting over nine months,  by increased focus on validation, improved reporting ownership, and effective use of all resources across Group hospitals, patient education and engagement and effective utilisation of scarce theatre space.  There had been a considerable decrease in trolley waits despite a significant increase in ED admissions.

The outpatient waiting list stood at approx 45,000 for July – 51 per cent of whom were waiting less than 12 months and this was a major challenge for the organisation. A high level action plan had been developed and was now in place to address key areas.

“The key clinical directorates are operating across the hospitals in the Group. We have asked Clinical Directors to do three things – set priorities for the year, take a share in the debt or give them a budget and set performance indicators. One key message is how clinicians and management work together that is how we do it in our Group. I hope they feel engaged. I know they feel empowered. We need to give them better tools, devolved budgets and information tools. We need to beef up their teams in some areas and we are carrying some vacancies. The next few months are important and the next few years are more important. We need to trust each other and play to each other’s strengths to get through it and I know we will.”

“Each hospital should deliver its own service and I look forward to the small hospitals framework. I want hospitals to appreciate that this is not downgrading but an opportunity to allow them to develop services of which their locality will be proud.  Following the closure of its Emergency Department, Roscommon felt threatened and there were lots of concern about the future. I would invite anybody to go to Roscommon now and tell me if it is the same hospital as it was a year ago.  It’s not, it’s better and it will be better still in a year’s time, when we add in more services.”