Ireland’s hospital centric model of care must be changed

Most health services have a hospital centric model of care which has to be changed to provide patients with the right services in the right place at the right time, in the way users want them, Dr. Áine Carroll National Director Clinical Strategy and Programmes Division, HSE, told the AGORA.

Dr. Aine Carroll
Dr. Aine Carroll

“At present, we are hospital obsessed. We use our hospitals as a default position for every health complaint, ranging from acute health episodes to domestic violence issues.

“We use them as a safety net for all sorts of conditions and that is not the best solution for good sustainable healthcare. In fact it can cause harm. Around the world, 25 per cent of patients suffer harm by being in a hospital system. Therefore, it is not right for us to continue with our hospital centric model of care because it can potentially cause harm.”

“In Ireland, we have a particular obsession with trolleys and delayed discharges and I don’t see this as the best way to judge a health service. We need to see beyond the hospital and provide solutions beyond the hospital setting.”

We use our hospitals as a default position for every health complaint, ranging from acute health episodes to domestic violence issues.

“Ireland faces real challenges with our ageing population, with chronic diseases, obesity and with our cultural attitude to alcohol consumption. These cause major problems for our health care system at primary and secondary care level.

“We have significant problems with health inequality, which we share with other countries, and we need to think societally about how we tackle these and the social determinants of health. We also have issues with a fragmented healthcare system and services that are often organised around the needs and demands of hospitals rather than patients and that is a real problem.

“Through various engagements, patients have said very clearly to us that we are not providing patient centred health care and we have listened to that.

Dr. Carroll, who was speaking on “Disruptive Innovation and the National Clinical Programmes,” said that slow incremental change was important to sustain any desired change.

She said she considered innovation as an idea, service or product, new to the HSE or applied in a way that was new to the HSE, which significantly improved the quality of health and care wherever it was applied.

She reiterated the popular saying – every system was perfectly designed to get the results that it got – and in her opinion if we wanted different performance, we must change the system and to change the system, we must think in fundamentally different ways.

This began with the National Clinical Programmes pursuing the quadruple aim – better outcomes, improved clinical experience, lower costs and improved patient experience.

“You cannot have improved patient experience without improved clinician experience and I would say improved management experience also, hence the HSE reform and transformation programme places care coordination for the patient, at its core.”

“You cannot have improved patient experience without improved clinician experience and I would say improved management experience also.

Dr. Carroll told the AGORA that over 30 National Clinical Programmes had been established since 2010, and were having a remarkable impact on the Irish healthcare system. The work of the National Clinical Programmes had ensured that:

  • Over 87,000 people with diabetes were screened as part of the national retinal screening programme.
  • An 82.3% day of surgery had been achieved for planned/elective trauma and orthopaedic surgery in 2015 compared to only 34.6% in 2010.
  • Twenty two severely obese adults with diabetes underwent bariatric surgery in Galway University Hospital in 2016.
  • There had been a 40% increase in the number of new patients seen for dermatology related issues since 2009.
  • Over 1,700 patients had been accepted to COPD outreach programmes across 12 hospital sites in 2016.
  • Eleven Injury Units were now seeing almost 90,000 patients with injuries such as broken bones, dislocations, sprains, strains, wounds, scalds and minor burns.
  • A total of 2,000 staff members had already completed the Adult National Sepsis eLearning module launched in September 2016, increasing competency and expertise on sepsis recognition, escalation and treatment.
  • An 11% thrombolysis rate for stroke patients was achieved by the end of 2015, compared to 1% in 2008.
  • Over 80,000 patients had been seen through MSK Physiotherapy Clinics and removed from consultant waiting lists.

“These programmes form the foundation of our integrated care programmes in the areas of Prevention and Management of Chronic Disease, Older Persons, Patient Flow and Children. There is evidence based data on the value of integrated care but the challenge now is to implement it.”

Dr. Carroll said integrated care was not for everybody and many people would continue to need episodic care but those who were older, frailer and have multiple co morbidities needed integrated care.

“Our vision for integrated care is person centred coordinated care and our objectives are to improve and standardise high quality care, support integration with knowledge and information management, increase accountability for integration and align finances with desired outcomes.

“The key principles of integrated care are to empower clinicians to lead the change, engage patients at every level, nationalise existing best practice, have strong support from the top table and align stakeholders.”

Dr. Carroll mentioned that there were many other innovative projects within the Irish health system one of which is the Epilepsy Lighthouse Project, providing individualised services and care in epilepsy which had led to the reduction in LOS (length of stay) of epilepsy patients over the age of 70 from 11.84 to 9.98 days in the Regional Hospital, Sligo.

“The key ingredient to our success is our staff. The care and compassion of our staff is a really precious ingredient for success and change .We need to nurture this and ensure we don’t lose it. I think healthcare across the world is in danger of letting staff burn out and if we cannot recruit and retain our staff in an environment that enables them to do their best, then healthcare is on a very perilous road.

“The human side of change is very important and you forget that at your peril. It is the hand that touches the patient that makes the change so it must be involved and looked after,” she concluded.