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Portiuncula Hospital Ballinasloe   Roscommon County HospitalNational Healthcare Conference        20 March 2013          t...
“It ought to be remembered that there is nothing more   difficult to take in hand, more perilous to conduct, or   more unc...
   Where have we come from?   Where are we now?   Where next?
   Greater efficiency   Growing demand   Growing expectation   Growing complexity   Organisational reform   Growing ...
 DOH Statement of Strategy 2011-2014 Future Health, 2012-2015 Transition from the HSE HIQA Tallaght Report HIQA Stand...
Hospital           Hospital             Level   Beds        Staff           University Hospital Galway       4      542   ...
   Groups of hospitals   National Clinical Programmes   Local accountability/empowerment   National Standards   Resul...
   Governance & Leadership   Implementation of Clinical Director Structures   Group Integration   Establishing the Boa...
3
   Proud to be at the heart of change   Unique opportunity   Proud to be test pilots for reform   Aim to deliver on ou...
Developing IT Solutions Implementing Clinical Programmes          Improving Access    Developing Financial Control        ...
   Group Governance Structure To establish sound       Clinical Directorate Structure - at the heartCorporate & Clinical...
Board Committees                      Board of Directors                 1.Finance                                        ...
   A job not a title   Engaged and empowered   Need to develop tools to support   Need to equip the team
   Clarified role of each Hospital   Implementation of National Model of Care Level 4, 3 & 2   Developing one Strategy ...
   Key Decision Making Group   Meets monthly   Informed by:     - CD Reports     - GM Reports     - Finance Reports    ...
◘   Noel Daly appointed as Chair◘   Terms of Reference/Committee Structures established◘   4 July Inaugural Board Meeting ...
Admission Rates                             Throughput                                              ED                    ...
◘   Developed Performance Management Culture   To develop Performance      ◘   Agreed KPI set for each Hospital  Managemen...
   Establishment of Group Finance Committee                                  Production of individual CCP for each Hospi...
   Inpatient Waiting ListTo meet national access  targets and restore                              Outpatient Waiting Li...
   Reduction in Inpatient Waiting List from 9,901 to 0   SDU Steering Group   9 Month PTL - 5 Point Plan       Increas...
Patients have been treated in all                                  Group hospitalsRoscommon:                              ...
   Major challenge for the organisation   Progress to date       High Level Action Plan developed to address key areas ...
   Comprehensive Bed Modelling Exercise using an in-house developed tool and supported by    some of the work by Dr. Orla...
AMU    Pt Flow       Cohorting   CMN Bed24/7   Meet 7.45am                          SSU                                  M...
2011       2012
◘   National Clinical Programmes Steering Group                                   in place  To adopt best practice and   ◘...
   Benchmarking – CIMS                              Understanding our cost base – ABCTo develop IT to support      Redu...
   Group ‘born’ on 9 January, 2012                     th   Established Corporate & Clinical Governance arrangements   ...
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
Bill Maher, CEO, GRHG
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Bill Maher, CEO, GRHG

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Galway & Roscommon University Hospitals Group

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Bill Maher, CEO, GRHG

  1. 1. Portiuncula Hospital Ballinasloe Roscommon County HospitalNational Healthcare Conference 20 March 2013 th Bill Maher, Group CEO
  2. 2. “It ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.”
  3. 3.  Where have we come from? Where are we now? Where next?
  4. 4.  Greater efficiency Growing demand Growing expectation Growing complexity Organisational reform Growing accountability 14
  5. 5.  DOH Statement of Strategy 2011-2014 Future Health, 2012-2015 Transition from the HSE HIQA Tallaght Report HIQA Standards Establishing the foundations for Trusts
  6. 6. Hospital Hospital Level Beds Staff University Hospital Galway 4 542 2500 Merlin Park Hospital 2 66 517 Roscommon Hospital 2 63 278 Portiuncula Hospital 3 158 644
  7. 7.  Groups of hospitals National Clinical Programmes Local accountability/empowerment National Standards Results driven Money follows patient
  8. 8.  Governance & Leadership Implementation of Clinical Director Structures Group Integration Establishing the Board Development of Performance Management Culture Human Resource Challenges (Retirements, Ceiling, Absenteeism) Financial Challenge 2012 €35m Access Targets (Trolley Waits, Waiting Lists) Implementation of National Clinical Programmes
  9. 9. 3
  10. 10.  Proud to be at the heart of change Unique opportunity Proud to be test pilots for reform Aim to deliver on our promises
  11. 11. Developing IT Solutions Implementing Clinical Programmes Improving Access Developing Financial Control Building CapacityEstablishing Performance Management Establishing sound Governance Establishing a clear vision and HLWP
  12. 12.  Group Governance Structure To establish sound  Clinical Directorate Structure - at the heartCorporate & ClinicalGovernance Model to integrate the Group  Group Integration  Executive Council  Board of Directors
  13. 13. Board Committees Board of Directors 1.Finance 2.Audit CEO 3.Quality & Patient Safety Group Executive Council (Chair CEO)Group Management Nursing Professional Clinical Directors Team Council Forum ( Chair COO) ( Chair GDON) (Chair Group CD)
  14. 14.  A job not a title Engaged and empowered Need to develop tools to support Need to equip the team
  15. 15.  Clarified role of each Hospital Implementation of National Model of Care Level 4, 3 & 2 Developing one Strategy / Vision for the Group Creating “Model Hospitals” Creating a sense of team through Clinical Directorates
  16. 16.  Key Decision Making Group Meets monthly Informed by: - CD Reports - GM Reports - Finance Reports - HR Reports - Nursing Reports Oversees: - Delivery of KPIs - Delivery of Cost Containment Plans - Quality & Safety - Priorities
  17. 17. ◘ Noel Daly appointed as Chair◘ Terms of Reference/Committee Structures established◘ 4 July Inaugural Board Meeting th◘ Appointment of Non-Executive Directors  Complementary skills  Local champions  Running the “business”  Remembering it’s a service
  18. 18. Admission Rates Throughput ED Admission Avoidance N:R ratio Nurse lead activityTo increase capacity Outpatients DNA rate Productivity through efficiency Waiting Times Diagnostics Availability Unnecessary tests Readmission Rates Day Case Rates Inpatients Length of Stay DOSA Delayed Discharges 1. Undertake for each Directorate 2. Create Clinical Champions 3. Establish Governance
  19. 19. ◘ Developed Performance Management Culture To develop Performance ◘ Agreed KPI set for each Hospital Management Framework to drive performanceimprovement & accountability ◘ Agreed KPI set for each Directorate ◘ Reporting Systems in place ◘ Key part of Communication Strategy ◘ Empower people and make them accountable
  20. 20.  Establishment of Group Finance Committee  Production of individual CCP for each Hospital  Engagement/Ownership by Clinical Directors in CCPTo establish a framework for Financial Control and  Established Income Focus Committees/Cost Control delivery of Cost Containment Plans Committees in each Hospital  Detailed Budget Monitoring Reporting on monthly basis  Established Employment Control Committee  Financial Reporting to Group Management Team, Group Executive Council  Established set of Financial KPIs for Group and each Hospital
  21. 21.  Inpatient Waiting ListTo meet national access targets and restore  Outpatient Waiting ListGalway’s reputation as a leading hospital  Trolley Waits in ED  Diagnostic Waiting Times
  22. 22.  Reduction in Inpatient Waiting List from 9,901 to 0 SDU Steering Group 9 Month PTL - 5 Point Plan  Increased focus on validation  Improved reporting ownership  Effective use of all resources across Group hospitals  Patient education and engagement  Effective Use of Theatre space Celebrated our success
  23. 23. Patients have been treated in all Group hospitalsRoscommon: Portiuncula: •GI Scopes •Plastic Surgery Patients from the GUH PTL were treated in the •GI Scopes •Urology following locations: •Urology •General surgery •General surgery •Maxillofacial Surgery •Sleep studiesMerlin Park: UHG: •Orthopaedics • All specialties, with •Pain particular focus on complex •Medical Interventions procedures
  24. 24.  Major challenge for the organisation Progress to date  High Level Action Plan developed to address key areas  Five Point Action Plan now in place to focus on initiatives such as converting review capacity to new capacity  Ongoing Validation – established Call Centre & wrote to 20,000 patients great than 12 months, with a 42% removal rate  Reducing DNA rate to target areas with long waiters
  25. 25.  Comprehensive Bed Modelling Exercise using an in-house developed tool and supported by some of the work by Dr. Orlaith O’Reilly Re-allocation of 25 surgery beds to medicine based on bed modelling exercise, to better reflect the actual demand for services Development of a comprehensive bed protection policy supported by Clinical Directors Development of the escalation policy & full capacity protocol for times of exceptional activity Appointment of a dedicated Patient Flow Coordinator for both Medicine and Surgery Appointment of a dedicated Discharge Coordinator Establishment of a Patient Flow Team with input from Nursing, Social Work, AHPs, Consultant and Management-Meeting 3 times a day at 8am (previously 9.30am) 12pm & 3pm Full opening of the Acute Medicine Unit on 24/7 basis (previously Mon-Fri 8 a.m.– 8 p.m.) Opening of a 32-bedded Medical Short Stay Unit (48hrs) - within existing resources Development of specialty specific bed compliments within Medicine and Surgery
  26. 26. AMU Pt Flow Cohorting CMN Bed24/7 Meet 7.45am SSU Meeting
  27. 27. 2011 2012
  28. 28. ◘ National Clinical Programmes Steering Group in place To adopt best practice and ◘ Re-engagement with National Clinical Programmes develop patient pathways toimprove quality & efficiency ◘ National Team Site Visits relating to 20 programmes to date ◘ Acute Medicine, Heart Failure, Epilepsy, Diabetes Foot Care, Elective Surgery & Anaesthesia all commenced ◘ Roll out of COPD, ACS, Asthma, Emergency Medicine and Palliative Care
  29. 29.  Benchmarking – CIMS  Understanding our cost base – ABCTo develop IT to support  Reducing storage cost and improving recordpatient care and improve efficiency keeping – Document Management Strategy  Improving quality systems & incident management – QPulse  Reducing Length of Stay, improving patient flow – Bed Management System  Theatre efficiency – Theatre Management System  Patient Involvement - PROMS
  30. 30.  Group ‘born’ on 9 January, 2012 th Established Corporate & Clinical Governance arrangements Developed Clinical Director Structure and support mechanisms Reduced Inpatient Waiting List from 9,901 to 0 Decreased trolley waits despite significant increase in ED admissions Developed Performance Management culture / KPI sets Integrated services within the Group Operating under WTE Ceiling / Reduced Absenteeism Re-engagement with National Clinical Programmes Delivering more activity with reduced spend Board now established

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