It’s not the fault of managers

When hospitals were over budget the simplistic view was that it was the fault of managers and not that there was high acuity of in-patients, an increasing population of older people, higher costs of available therapies and a high use of itinerant agency staff, Dr. Tony O’Connell HSE National Director Acute Services told the Conference.

Tony O'Connell
Dr. Tony O’Connell

“We have lack of flexibility in our bed management, largely contributed to by the fact that there are the equivalent of 30 wards full of patients who have been ready for discharge for weeks.

“The austerity programme cut and placed a ceiling on permanent staff and then because demand went up we are buying more expensive staff to fill the gap. We also have challenges in getting people to stay in the system. This is not only challenging the delivery of high quality care, but our ability to do anything as efficiently as we could.”

Dr. O’Connell, who delivered budgetary surpluses during his time working in Queensland, said the Government and public wanted easy access to services and smooth patient flow, excellent patient experiences and satisfied staff, high quality outcomes, safely delivered – and all delivered within allocated resources.

“We should set a vision for what the public health system should look like. We should use burning platform and classic change management principles, position accountability at a local level, rigorously apply a system performance management approach, promote innovation, redesign and improve productivity and specifically explore partnerships and contestability.

“We need to explore what the system will look like when we go through the change process, reflecting the expectations of the average person in the State. It is very powerful to put that in simple language with which the average person in the street can resonate.

There should be collaboration between clinicians and managements and frequent use of the patient voice.

“We need to empower staff and patients to have an input as to how the system should look. From ‘below’ there should be collaboration between clinicians and managements and frequent use of the patient voice. From ‘above’ there needs to be clear direction as to what is expected, clear targets which are widely known and with consequences, cascading accountability throughout the system until we finally get to the stage where trusts can run their own business unfettered.”

Dr. O’Connell said we would have to redesign and train for leadership. The first phase of what had to be done would be to diagnose what was wrong, use data, including patient stories and turn them into solutions to address problems.

“In Queensland clinical service redesign in 19 of the largest hospitals produced a return on investment at least five fold. There was an improvement across the balanced scorecard – quality and safety, patient experience, budgetary performance, better access performance in elective surgery and EDs and shorter stay.

Despite a 4 per cent rise in attendances time in ED had decreased by almost two hours over the past two years and there was improved performance on national targets. LoS reduction was the equivalent up freeing up 440 beds.

Dr. O’Connell said that together, the following strategies would make our public health system more affordable and sustainable:

  • Robust performance management of the system.
  • Changed governance arrangements to give more control and accountability to the local level.
  • Clinical service redesign programme with an emphasis on spreading and sustaining better ways of working.
  • Exploring value-for-money opportunities through partnerships and contestability, improving productivity of our staff.