Leading large scale change

Tallaght Hospital in Dublin doubled the number of patients going through its Emergency Department between March and September last year, the hospital CEO, Ms. Eilish Hardiman told the 9th National Health Summit in Dublin.  Maureen Browne reports.

Tallaght Hospital in Dublin doubled the number of patients going through its Emergency Department between March and September last year, the hospital CEO, Ms. Eilish Hardiman told the Conference.

Ms Eilish Hardiman, Dr. Ambrose Mcloughlin and Prof. John Crown
Ms Eilish Hardiman, Dr. Ambrose Mcloughlin and Prof. John Crown

Ms. Hardiman, who was one of three panellists speaking on “Leading Large Scale Change in such Challenging Times“ said that the percentage of patients seen in three hours had doubled from 30 to 60 per cent.  The hospital was admitting about 120 fewer medical patients a month on foot of the implementation of its acute medicine programme.

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She said that she took up the post of CEO 18 months ago and since then the focus of the Board in had been on patient safety, good governance, strong financial stewardship and the management competencies and capabilities to deliver on this had been implemented.  Seventy per cent of the HIQA recommendations had been implemented by the end of last year.   No patients were waiting more than nine months for in-patient care.    A financial strategy with a two year plan was being implemented and the hospital hoped to break even this year.

“My vision is to focus on population health. The acute system will not and cannot deliver on its own. There needs to be total alignment with community services.”

“Tallaght could not have made these changes in the last 18 months without the commitments of the 3,000 people working there to make changes. I am very heartened by our committed workforce, our clinical leadership is phenomenal. We need to facilitate and allow staff to make changes and give them the reins to do so.

“My vision is to focus on population health. The acute system will not and cannot deliver on its own There needs to be total alignment with community services.”

Dr. Ambrose McLoughlin, Secretary General of the Department of Health told the Conference that everybody in the system was highly valued and everybody had the opportunity to make a contribution.

“I believe the Health Management Institute has a very important role in ensuring continuing professional development for their members.”

“I believe the Health Management Institute has a very important role in ensuring continuing professional development for their members.”

He said he would like to see seventy to eighty Primary Care Health Teaching Centres attached to teaching hospitals around the country. He believed alignment between the new hospital groups and the medical schools was profoundly important.

Ultimately, it was the leadership role of all the clinicians, including doctors, nurses etc, that really delivered the change surge.

“We will be looking at fairly significant governance changes and new structures which will mean that we will have to move ultimately to an executive role for clinical people.

“Patients must be at the heart of decision making and their care and treatment processes and we must encourage active involvement by patients and their families in their own care and treatment.

“We also need to build relationships that will endure with communities. We have to have dialogue about alcohol and physical activity. This is about everybody working together on the same agenda and delivering for patients.”

The ultimate logic of a system that empowered patients by universal insurance was that there would be mass unemployment of people who were currently designated as officials as they would not be needed.

He said the Clinical Care Programmes were truly magnificent and he would like to compliment former HSE Director, Dr. Barry White and all the Clinical Leads for their work in implementing them.

“We will be enhancing and supporting the clinical leadership and the general leadership.”

He said a medicines management programme was in place in the HSE to address the most cost effective prescribing. He also said that the pharmaceutical industry had 100,000 staff and contributed €40 million annually to the country.

Senator Prof. John Crown, Consultant Oncologist, St. Vincent’s University Hospital, Dublin said that the ultimate logic of a system that empowered patients by universal insurance was that there would be  mass unemployment of people who were currently designated as officials as they would not be needed and power would be transferred to the clinicians and the people. He said that under this system we would not have a national consultant contract.  Some consultant would become full time, others would have different arrangements.

He said that one of the problems was that all consultants in Ireland were co-equal, as there was no appropriate career progression system once consultants were appointed

He did not share the certainty of many in the audience that administrative and organisational changes would actually fix the problems of the health services. “I don’t think they will make a big difference.”  He criticised the fact that there was not one medical person on the UHI implementation group. He said that he did not see the cancer programme working and that was the only one about which he could speak.

“There are economies of care and more seamless complex care can be delivered when hospitals come together.  We have probably two to three too many hospitals in Dublin and the population has two or three times more medical schools than the European average.  We have one medical school for 1 million population while the European average is one for 1.5 million.

He hoped every press consultant would be sacked and every PR person fired, so that people in authority would have to come out and face the media themselves.