RCSI Group wants to be first Trust

The ambition of the RCSI Hospitals Group, Ospideil RCSI, was to be the first Hospital Trust in the country, Mr. Bill Maher, CEO, of the Group said when he addressed HMI fora in the Dublin North Eastern and Dublin Mid Leinster regions.  Maureen Browne reports.

Bill Maher
Mr. Bill Maher

The ambition of the RCSI Hospitals Group, Ospideil RCSI, was to be the first Hospital Trust in the country, Mr. Bill Maher, CEO, of the Group said when he addressed HMI fora in the Dublin North Eastern and Dublin Mid Leinster regions.

“Some of the biggest challenges for me are to set up governance and leadership structures, to integrate the group consisting of statutory and voluntary hospitals with their own cultures and ways of doing things.

He said new planning and service models would have to be introduced, which would take into account the demography in designing services. They needed to look at the type of population in the Group area and their projected use of services. For example they would need to map the number of young people, the number of older people, those with chronic diseases and very high intensive users (VHIU).

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“We are a service driven organisation. People deliver services and I want us to run more like a business and I think we are bringing in some of the efficiencies which industry may offer us.”

We need to start changing the way we do things or this time next year we will have 600 patients waiting on trolleys again.

In his presentation he said that in his opinion even one person on a trolley was unacceptable and that if we did not start to do things differently we would have 600 delayed discharges in the country’s acute hospitals again this time next year.

The hospitals in the RCSI Group are Beaumont, (Level 4 teaching hospital) Connolly, Drogheda and Cavan (Level 3), Dundalk and Monaghan (Level 2 hospitals) and the Rotunda Maternity Hospital in Dublin. It also includes St. Joseph’s Hospital,Raheny which, Mr. Maher said, was managed by Beaumont and was an important part of how it functioned and should be acknowledged and recognised in its own right. The Group has a total of 2,238 beds and over 6,000 staff.

“Some of the biggest challenges for me are to set up governance and leadership structures, to integrate the group consisting of statutory and voluntary hospitals with their own cultures and ways of doing things. The voluntary hospitals are very proud of their traditions.

“I hope we will operate as one group across seven sites. We are going to do the best we can within the constraints we have to provide the best care for the population and patients we serve. The boundaries we used to have need to be irrelevant as far as possible. The challenges are change management, winning the hearts and minds of the public, patients, staff and all stakeholders.

My vision for leadership is to give staff the tools to do the job and let them get on with it, and then remember to say ‘thank you’ when they deliver good service. to do a good job.

Mr. Maher, was speaking on “Vision for the future with a bias for action.” He was formerly CEO of the Saolta Group and set up one of the first foundation trusts in the UK.

“So when people tell me we are going to become a trust I have a very clear idea of what this is and the faster we get there the better. We want to engage people and get their views, get them on board, get moving quickly. We need to establish this group and deliver on all the promises.

“Our academic partner is the RCSI – they are truly world class and give our Group an unique opportunity to deliver the research and education agenda – to me health delivery, education and research are three legs of the one stool.”

“Groups will have to ensure we have a good grip on performance and demonstrate greater financial control. If we were to become a Foundation Trust, two of the entry qualifications in the UK would be sound and sustainable financial performance and high quality service delivery.

“Trolley waits across the country are at an unacceptable level and is not the service that we would like to provide for our patients. Trolley waits in hospitals are symptoms of system and organisational problems. If you have over 850 delayed discharges this is an indicator that something is wrong. We need to start changing the way we do things or this time next year we will have 600 patients waiting on trolleys again.

“We have to ensure we have effective management in all of our hospitals and what is clear is that quality and safety is very important. This time next year we should be able to show that we have done various things to address the major challenges if the Group is to be successful. We need to be better engaged with the public, stakeholders and all staff who are trying to deliver the service. I start off with a sincere belief that most people come to work every day. to do a good job. Most people are tired of hearing how bad our health service is. My vision for leadership is to give staff the tools to do the job and let them get on with it, and then remember to say ‘thank you’ when they deliver good service. Our investment in training, education and management has been pretty poor in recent years. We need to make a lot of effort now to engage and develop our staff and help them give of their best.

Mr. Maher said the HIQA report on Tallaght gave the guiding principles of governance, particularly the composition of Boards based on competencies. “There is also provision for the Groups to hold at least two meetings a year in public. We did in Saolta and it was not as scary as you think.”

He said the seven groups met on a regular basis to try and ensure consistency of approach, to support each other and agree some big ticket issues. “We want to ensure consistency of approach across all Groups. We should not be afraid to copy somebody who is doing something really well. Furthermore we don’t all have to do the same thing wrong to learn from it.

“We need to develop clear service planning, ensure a greater grip on performance, a greater emphasis on quality and safety, greater engagement with the public and stakeholders and improved staff engagement and development.”

Mr. Maher said that there was a need to improve access times, deliver high quality and safe services, integrate the group, implement clinical directorate structures and get to grips with HR challenges of engagement, recruitment and retention. I have the view that a Clinical Director is a job and not a title. It is a serious leadership role which you have to apply for and be recruited because you are the best and not because you work in a Level 4 hospital. I would also have the view that you do not have to be a consultant to be a clinical director but I don’t think Ireland is ready for that yet. When we are a Trust I would be happy to have that discussion.

“The first thing I did was to establish a Group Executive Council comprised of CEOs and General Managers of the constituent hospitals. I want to get the Group Management Team up and running – Professor Paddy Broe, former President of the RCSI is our Group Clinical Director, we have advertised for a Group Director of Nursing and I think we need a Group Director of HR and a CIO. We are now thinking of our clinical directorate structure. One message I am giving to everyone is that every hospital has a part to play in the success of the group.