A major programme of reconfiguration of acute hospital services originally in the Cork and Kerry Hospital and subsequently extending to all of the South/South West Hospital Group, was one of the six finalists for the HMI Leaders Award Major Project category.
The aim was to avoid duplication between hospitals, concentrate specialties within one centre where possible, develop outreach services, and deliver safer, more efficient more sustainable services and improved patient benefits, writes Sinead Glennon writes Sinead Glennon Head of Mental Health, Cork and Kerry, who carried out the project.
In 2009, Prof. John Higgins was appointed as Director of Reconfiguration for Acute Hospital Services in Cork and Kerry, charged with reviewing all aspects of the design and delivery of acute hospital services to develop a realistic, implementable plan on how hospitals should be structured and delivered in order to achieve better patient services and outcomes and more value for money. Prof. Higgins and his team consulted with over 40 subgroups representing every specialty delivered in the hospitals. Over 500 HSE South staff from a variety of disciplines were involved in these subgroups. Reconfiguration of Acute Hospital Services, Cork and Kerry, a Roadmap to Develop an Integrated University Hospital Network was published in November 2010.
Implementation of reconfiguration within the SSWHG to date has utilised the following strategies:
Establishment of a hugely committed, motivated and enthusiastic small team of staff (led by the Director and including an executive lead, an administrative support, and representation from nursing, allied health professionals, UCC, public health, hospital consultants and communications) who were overwhelmingly dedicated to taking on board the recommendations coming in from the specialty sub-groups and worked tirelessly to ensure they were implemented for the benefit of the patient.
A Reconfiguration Forum which comprised the major influencers and staff with the power to make the changes being sought. This included all of the CEOs of the hospitals involved, along with representation from HSE management, clinical directors, directors of nursing, primary care, mental health services, GPs, academics, NCCP, HR, and finance to guide the process. It was the first time voluntary and HSE hospital managers, clinical leaders, and primary care and academics had met regularly for such a sustained period.
Establishment of a Non Executive Advisory Board comprising some of Ireland’s top entrepreneurs and academics. Board members offered their time and expertise free gratis to guide the process and assist in overcoming challenges.
The development of a strategic engagement and communications strategy from the outset ensured that staff, unions, key influencers in local communities and patients and their families were informed in advance of the forthcoming changes so that they got a chance to negotiate and debate them with the reconfiguration team in advance, ensured that there was no opposition to the changes once implemented. Town hall forums were held throughout the length and breadth of Cork and Kerry at ICA, county councilor, business organisation, schools and islander meetings. The team also maintained close engagement with the medical training bodies, unions and the HSE’s national clinical care programmes.
Individual project teams were established to progress each service move. Each project team had management and clinical co-chairs, and a dedicated project manager. Basic project management training and standardized documentation was provided to the PMs.
A detailed ‘lessons learned’ session was completed after all major service reconfigurations to ensure that learning was captured and utilised in future planning.
‘Quick wins’ were identified and pursued to maintain momentum.
Lean training for staff involved was provided.
Once established, the SSWHG began a similar process of engagement, with the Leadership Team meeting with individual clinical specialties from across the group. These meetings will inform the strategic plan for the Group.
Highlights of the reconfiguration of services within the SSWHG to date include:
Transfer of over 800 staff without any major industrial relations issues.
Transformation of one hospital from an acute hospital with a 24/7 ED to a dedicated elective hospital – providing protected theatre time without interruptions from emergency patient arrival.
Streamlining acute services with reduction in the number of EDs and hospitals performing emergency surgery in Cork from five to two, supported by the introduction of advanced paramedics and intermediate care vehicles. Development of Local Injury Units (LIUs) and Medical Assessment Units (MAUs) at the other sites to support the two 24/7 EDs. LIUs developed have achieved a 65 minute average time from patient attendance to discharge.
Transfer of a the stand-alone Orthopaedic Hospital into the dedicated elective hospital at SIVUH resulted in the same quantum of service being provided with a reduced number of staff and redeployment of remaining staff to open 50 long stay beds in Community Nursing Units and enhance support services at CUH. The new model of care at SIVUH enabled achievement of best in the country for length of stay for hip and knee replacements and a 48% reduction in the number of patients waiting to be seen in the first year post service reconfiguration. The service reconfiguration also allowed re-establishment of a paediatric orthopaedic service in Cork, within existing resources, after a four year gap.
Reconfiguration of services at the smaller hospitals within the group (Mallow and Bantry) by reforming ED services to LIUs/MAUs, cessation of emergency and inpatient surgery and development of strong day surgical services with visiting outreach consultants from Cork city hospitals has provided safer, more sustainable services.
Concentrating specialist services in locations. Examples of this include:
- Consolidation of cardiology in a new purpose built unit at Cork University Hospital
- Consolidation of pain medicine, plastic and maxillofacial surgery from two sites to a purpose built unit at SIVUH. Through adoption of Lean principles for the pain service, a 49% reduction in the number of patients on the waiting list in the first 12 months following transfer, and a reduced wait time from three years to nine months was achieved.
- Consolidation of all gynaecology cancer surgery at Cork University Maternity Hospital facilitated by reciprocal transfer of benign surgery to the SIVUH. This has resulted in all cancer surgery being performed in a designated cancer centre and an increased throughput of benign elective surgery at SIVUH.
- Significant savings in NCHD out of hours on call through amalgamation of services on one site or establishment of cross city on call arrangements.
- IT improvements including roll out of iPMS, and development and roll out of electronic general referral from GPs to outpatient clinics as the Reconfiguration Team hosted the national pilot for this project.