Reconfiguration – a huge learning process

Dr. Gerard O’Callaghan, Chief Executive Officer, South Infirmary-Victoria University Hospital, Cork describes one hospital’s experience of the reconfiguration of acute hospital services in Cork and Kerry.

A Forum consisting of clinicians and management from the Cork and Kerry hospitals as well as representatives from community care services, general practitioners and University College Cork was established under the chairmanship of Professor John Higgins in 2009. The role of the Forum was to make recommendations regarding the future configuration of clinical services that would ensure the best possible health outcomes for the people in the region. The fForum’s report, which was launched in November 2010, recommended a major reconfiguration of clinical services in all of the acute hospitals and set out a roadmap to develop a single integrated university hospital network for Cork and Kerry.

The report recommended major changes to the South Infirmary-Victoria University Hospital (SIVUH) which would result in the hospital closing its Emergency Department and no longer providing acute medical or acute surgical services. It would also lose its cardiology and medical rehabilitation service. The hospital would effectively become an elective surgical hospital with a number of regional specialties and a large day procedure and outpatient service. This type of hospital model, whilst unusual in Ireland, would not be unusual in other countries. The major benefit would be that, as the hospital would be purely elective, it would not be cancelling patients because of pressures from emergency admissions and would thus provide a more efficient service to the public.

The reconfiguration of services commenced in November 2011 and its current status is:

Services transferred out of SIVUH

Services transferred to SIVUH

Services planned to move to SIVUH

The reconfiguration of services has been a major challenge for everyone involved but it has been especially difficult for the staff at SIVUH. The hospital has been to the forefront of the service moves to date and has been affected more by reconfiguration than any other hospital in the region. In particular the closure of the Emergency Department and the loss of so many specialist staff have been particularly difficult for the hospital. Neither has it been easy for people who have worked for many years in one organisation to find that they now have to move to another organisation if they wish to continue working in their chosen specialty. Over 500 staff across the city have been affected by all of the moves to date. Whilst there was much discussion and consultation within the organisation about the service moves, and whilst there was a general acceptance that the recommendations were in the best interest of the patient, it was still very difficult for people to make the move.

In order to ensure the smooth transition of services basic principles were agreed with the HSE, and accepted by the trade unions, governing staff movement between organisations.

The main principles were:

• All staff to retain their existing terms and conditions
• No redundancies or job losses
• Commitment to maximising voluntary redeployment
• It was accepted that staff deemed essential to a service would transfer with that service

Participating in the reconfiguration of services has been a huge learning process for all of us and I’m sure with the establishment of Hospital Groups that many other hospitals will soon be embarking on a similar process. It is not possible in this short article to discuss in detail all of the issues that arose during the process but there are a number of points worth mentioning. Early engagement with all stakeholders is critical for the success of the process. We commenced a formal engagement with staff and unions at an early stage.

It may seem obvious but a major investment of time will be necessary for all participants. It is also very important to ensure that the emotional impact of change on individuals is not underestimated. These situations have to be handled with great care. Another area where we had great difficulty was in getting agreement on resource requirements, both financial and human, between each participating organisation. If this is not done correctly then an organisation runs the risk of ending up in financial difficulty. It is also important not to underestimate the potential income loss to an organisation when it loses a service. Getting agreement on these resource issues should be done as early as possible in the process. Finally, despite the best of planning always expect the unexpected!

When the reconfiguration process is complete the SIVUH will primarily be an elective surgical hospital with a particular concentration on day surgery and patients with short lengths of stay. It will also be the regional centre for the following specialties:

• Orthopaedics (Elective)
• Orthopaedic Trauma Rehabilitation
• Otorhinolaryngology (ENT)
• Ophthalmology
• Plastic Surgery
• Gynaecology Surgery (Elective benign)
• Pain Medicine
• Dermatology
• Rheumatology
• Endocrinology

I am regularly asked if I regret getting involved in the reconfiguration process. I must say that there are times when I worry about whether we made the correct decisions when formulating the plan but I definitely do not regret getting involved. While we are currently in a situation where we have lost more services than we have gained, this situation will turn around when the process is complete. In any event in the current environment the status quo is no longer acceptable and we will all have to change if we are to survive.