The first round of detailed patient costings involving about 12 hospitals should be available this year, Dr. Barry White, the HSE’s National Director of Quality & Clinical Care told the HMI Forum.
He said the quality and safety risk agenda was about improving outcomes – otherwise we are wasting money. While we must of course meet our legal requirements, outside of this we must challenge ourselves with the question of improving outcomes.
While most people working in the health services believe they are underfunded for what they do, information has not been available up to now about what is happening to patients and the costs in the different areas.
“We expect to get an itemised bill in a restaurant and we should be able to have an itemised breakdown of the cost of patient care. It should be broken down and coded into the costs of doctors, nurses, allied health professionals, medication etc.”
He said the key components of quality system were infrastructure (including IT), governance and treatment guidelines, and audit and risk management.
Effective governance
White said that work needs to be done to ensure we embed an effective Governance model within HSE services. This means ensuring accountability, authority and responsibility are clearly defined at each level within the organisation. He was not necessarily convinced we have effective governance with the links between authority and responsibility. Individual hospitals have done it but there was no national approach.
It would also be important to have guidelines on the management of various conditions. For example, how does the Irish health system manage asthma between hospital and the community? We couldn’t say how we managed it, and, although they had been drawn up, there were no guidelines mandated throughout the system.
Quality and safety risk agenda is about improving outcomes – otherwise we are wasting money
In introducing guidelines he said we should look first at areas like chronic diseases such as respiratory disorders, cardiovascular disease and diabetes where most people died and most money was spent. They had the greatest potential to improve quality and reduce costs.
He said a starting point in the current changes were that successful transformations occurred with clinical leadership. This means clinicians working in partnership with existing management.
The operating principles of his Directorate were to keep it simple, keep it timely, target what is achievable, measure what is done, involve patients, have local ownership and focus on outcomes and output. Everything that was done had to be judged against the quality, access and cost.
He said that micro management by the HSE affected the successful delivery of services on the ground. There had to be a local ability to deliver solutions that fitted into the national agenda. People who are responsible did not always have the necessary authority.
Dr. Barry White
