Clinical Leadership, Maternity and Child Care

1. Clinical LeadershipClinical Leadership
Maternity and Child HealthMaternity and Child Health
Dr. Roy K Philip
Consultant Paediatrician & Neonatologist
University Hospital Limerick
Limerick, Ireland
roy.philip@hse.ie
@roykphilip

2. DisclaimerDisclaimer
• Conflicts of interest: Nil to declare
• Clinical Bias: Actively promote breastfeeding among
premature infants
• Communications: Voice views through Social /
Professional media including

3. FormatFormat
• Clinical leadershipClinical leadership
• Value in healthcareValue in healthcare
• Positive developmentsPositive developments
• Clinical innovationsClinical innovations
• Some storiesSome stories
• Personal viewsPersonal views

4. Clinical leadershipClinical leadership
• Clinical governancegovernance.
• InitiatingInitiating and implementing changechange.
• Clinical performanceperformance enhancement.
• Healthcare professionals leading innovationinnovation.
• Reform of healthcare and patient services.
• Buy-inBuy-in and creation of effective teamseffective teams.
• ProcessProcess improvement.
• (Availability), accountability and authority.

5. HSE Corporate Plan- sets out an ambition for the Health Services over the three years ‘15–’17.
Delivery of the vision of a ‘high quality health service valued by all’‘high quality health service valued by all’

6. ““Value” is not a bad wordValue” is not a bad word
• Michael PorterMichael Porter, Harvard Business School, and others have
been pointing out for years that in health care, “value”in health care, “value”
means something else: achieving goodmeans something else: achieving good
outcomes as efficiently as possibleoutcomes as efficiently as possible.
• It may never be expressible as a numerical rationumerical ratio (quality divided
by costs) that allows meaningful comparisons among providers.
• But measuring outcomes and costsmeasuring outcomes and costs does allow providers to push
for improvement—and to learn from their competitors.

7. MaternityMaternity
• Key clinical guidelines - sepsis management, management of a critically ill
women, clinical handoverhandover, labour ward huddlehuddle.
• Implementation of Maternity Early Warning System (IMEWSIMEWS) in the 19
maternity units.
• Development of Cardiotocography (CTGCTG) trace training modules.
• Clinical governance and senior clinical decision makingsenior clinical decision making in all of the units.
• Reporting by the 19 maternity units on 30 quality assurance indicatorsquality assurance indicators.

8. More to do......More to do......
• Standards of care-adverse outcomes / miscarriage.
• Service userService user feedback integration.
• Optimisation of patient to clinical workforce ratio.
• Primary carePrimary care and maternity services.
• National maternity strategy.
• Clinical business informationClinical business information.
• Activity based funding in maternity services.
• MN-CMSMN-CMS (Maternal & newborn clinical management system)
• New maternity hospitals (Dublin & Limerick)

9. Child health – acute careChild health – acute care
• National clinical programmes in Paediatrics and
Neonatology.
• Timely, safe and efficient retrievalretrieval services.
• Infants and children with surgicalsurgical needs.
• Integration with child health in primary care.
• Implementation of PEWSPEWS.
• New Children’s Hospital.
• How the NCH integrate and interact effectively
with regional centres to create a seamless modelcreate a seamless model
of ‘hub and spoke’of ‘hub and spoke’.

10. Clinical innovationsClinical innovations
• Service developments linked to innovation.
• Projects underpinning access, equity and costaccess, equity and cost.
• Projects on paper (presentations) to patient.
• Learn and adaptadapt from successful small countries.
• Effective clinical leadershipEffective clinical leadership is critical.
• DataData and evidenceevidence as the ‘fuel’ to drive.
• ArticulateArticulate your vision and (collectivecollective) mission well.

11. True story 1True story 1 – service development– service development
• Development of first paediatric high dependency
unit (critical care level II) outside of Dublin.
• Pooling of resources to care locally with safetyto care locally with safety.
• Reduction of critical care transfers by 50%
• Reduction of ICU admissions by over 70%
• Considerable cost savings over the five years.
• Future model for NCH ‘hub and spoke’.
• NoNo ward level ‘crashes’ or ‘cod blue’.
• National level awards – benefit to community.

12. PAEDIATRIC HIGH DEPENDENCY UNIT
AT LIMERICK REGIONAL HOSPITAL
WIN COMMUNITY FUND
The Limerick-based Paediatric High
Dependency Unit bet off strong
competition from organisations
representing other counties and
received the majority of the
30,000 votes cast by the public to
help it win the competition.
PHDUPHDU
G. Reddin, A. Hannigan, R. Philip
Graduate Entry Medical School, University of Limerick

13. IRELAND
In 2013, 55.8%55.8% of mothers were breastfeeding on discharge from
hospital, 46.6% exclusively.
Figures for 2012 showed that five out of every 10 babies born in Ireland
were being breastfed on leaving hospital.
This compares with eight out of every 10 in the UK.
Across Europe on average nine out of every 10 babies born are breastfed,
with almost all babies born in
Norway, Denmark and Sweden being breastfed.
Less than 10% at 6 months of age.

15. True story 2True story 2 - QIP- QIP
• Breast milk for premature babies.
• From below 20% to 100%
• ZeroZero Necrotising enterocolitis (NECNEC) at UMHL.
• Maintenance of success for the third year.
• Saving of over €250,000
• Through QIP, buy-in, parent in the treating team.
• International black spot to hot spot in breastfeeding.
• International acclaim – awards & publications.

16. • A 'NEC free NICU' through breastfeedingA 'NEC free NICU' through breastfeeding
quality improvement project (QIP)quality improvement project (QIP)
• RK Philip, A Ismail, C Quinn, M Dunworth, A
Hannigan, M O'Leary
• Pediatrics 2015; 135:Supplement 1 135S1;
doi:10.1542/peds.2014-330W

17. Excellence in Pediatrics (EiP) – world congress.Excellence in Pediatrics (EiP) – world congress.
Best educational project award – 70 countries and over 2000 participants.Best educational project award – 70 countries and over 2000 participants.

18. Breast milk: the best lovebioticlovebiotic
• Crealey MR, Ludusan E, Philip RK.
• J Perinatol. 2015 Aug;35(8):665. PMID: 26219700

19. True story 3True story 3 - audit- audit
• Bed utilisation study.
• How are we utilising our scarce bed-stockscarce bed-stock.
• First paediatric review with input from public health .
• To audit own practices and compare internationallycompare internationally.
• Paediatric appropriateness evaluation protocol (PAEP).
• Children’s Ark at UHL – 96.6%96.6% appropriateness.
• ParityParity in public, private and out-of-hours.
• International recognition.

20. Original Article. Published: 10 May 2016
Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric
Appropriateness Evaluation Protocol (PAEP)
Coilín ÓhAiseadha1, Mai Mannix1, Jean Saunders2, Roy K. Philip3*
Increasing demand for limited healthcare resources raises questions about appropriate use of
inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland,
we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional
Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined
hospital activity data, to make recommendations for optimal use of inpatient resources.
Conclusion: At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6%
appropriate admissions.
Citation: Int J Health Policy Manag. 2016;5(x):x–x. doi: 10.15171/ijhpm.2016.53

21. 5 Simple tips – our experience5 Simple tips – our experience
• Goal-setting - make you feel proud
(If the goal, when achieved, won’t make you proud, don’t bother to go for it!)
• Break it down- break your goal into the smallest possible granule.
• Every single day – ‘work’ on your goal every single day.
• Celebrate small victories – may be small for you.
• Process matters - no marathon is done or won by just thinking.
(Instead focus on its process)

22. Clinical Leadership Competency Framework (CLCF) NHS
2011 NHS Leadership Academy.

23. Generally speaking, the number of people an
organization needs to train in process improvementtrain in process improvement
is the square root of the total number of personnel.
Rule of ThumbRule of Thumb
Thomas H Lee, MD, chief medical officer at Press Ganey Associates.
Engaging doctors in the health care revolution ...
HRB 2010
Turning Doctors into Leaders
Thomas H. Lee, MD

24. Clinical leadershipClinical leadership
• Initiating change
• Effective clinical leadership
• Clinical innovation
• Value in healthcare
• Adapt, Articulate, Buy-in
• Collective mission
• Goal – feel proud
• Break it down - process
Dr Roy Philip Clinical Leaders Summit
26th May 2016

25. roy.philip@hse.ie
@roykphilip
Breast milk: the bestBreast milk: the best lovebioticlovebiotic