Dr. Peter Lachman is working to build a cadre of Irish healthcare leaders – both clinicians and managers – who will know what to do in order to improve healthcare processes, experience and outcomes.
The development of continual improvement in service is the Holy Grail which all of us pursue. As managers of healthcare services we all aspire to a process where the patient receives the care needed the first time every time, without delay and at low cost. One may assume that this is not possible, however it has been achieved in other countries. I have yet to find a healthcare provider, be it clinicians or managers, who do not want to do the best for their patients. All want to improve healthcare but often find it difficult to do. There are many reasons for this difficulty. Usually the main obstacle is lack of time as we are all very busy, constant crisis management of real issues and often ones we have helped to create consumes most of what we do. We live in a system where the lack of resources seems to be the major problem, yet where the waste of resources is as large an issue. Healthcare is now very complex due to the changing nature of our patients, the complexity of the provision of healthcare. Finally there is decreased funding to achieve the outcomes we would expect for ourselves.
The daily problems we face include decreasing the number of patients on trolleys, having more patients treated in the ED, dealing with discharges etc. And underlying it all is the very real challenge of rising expectations for person centred care within a tight budget and rising. W. Edwards Deming, the pioneer of QI once said: “Hard work and best efforts will not by themselves dig us out of the pit”. Many people in healthcare are working extremely hard, yet the problems seem to grow. Deming also said “It is not enough to do your best; you must know what to do, and then do your best.” To address these two issues I have been working in Ireland to help to build a cadre of healthcare leaders – both clinicians and managers – who will know what to do in order to improve healthcare processes, experience and outcomes.
Rather than teach theory the programme is designed to incorporate experiential learning.
Over the past four years, the RCPI working in partnership with the HSE has offered a Diploma in Leadership and Quality in Healthcare in order to enable significant changes in patient safety and quality. http://www.rcpi.ie/article.php?locID=1.10.396.405 The programme is “designed to guide senior management and clinicians in leadership and quality so as to improve patient safety within their workplaces”. The Diploma is aimed at senior level healthcare personnel such as Clinical Directors, Directors of Nursing, Hospital CEOs, Clinical Care Programme Leads, AHP Leads, GPs, Primary and Community Care Leads. Diploma 8 and 9 are due to begin their learning cycle in September. So far we have trained over 200 leaders in the Irish health system, first as individuals and now in teams.
The course contains theories of change, improvement and implementation science, patient safety and reliability, and leadership. Rather than teach theory the programme is designed to incorporate experiential learning. Each participant is responsible for a Quality Improvement project – usually as part of a team. This allows learning to be real and to mean something to the participants. Projects are varied from developing governance at board level. To improving waiting times in outpatients, starting theatre lists on time, improving medication safety, decreasing cost of processes etc. All need to be person/patient centred. The key theories included are concepts of quality improvement methodologies, improving patient-centered care, understanding flow and developing leadership skills, principles of patient safety key concepts of leadership & team-working and how to obtain real value from what we spend on healthcare.
Over the next few months we will highlight the learning with some project reports and the theory that allowed the successful outcome.
Dr Peter Lachman is the Quality Improvement Lead Faculty for RCPI and the National Quality Improvement Programme (HSE/RCPI). In 2005-2006, Peter became a Fellow of Quality Improvement at the Institute for Healthcare Improvement in Cambridge, Massachusetts. His current position is Deputy Medical Director (Patient Safety), Great Ormond Street Hospital for Children NHS Foundation Trust. He is also a Consultant Paediatrician at the Royal Free Hospital Hampstead NHS Foundation. His current interests are in patient safety and designing services that are safe and person friendly at the same time