2. The Royal National
Throat, Nose and
Ear Hospital
Challenges of managing a newly
merged clinical service
Presented by : Neeta Lakhani
3. The Royal National
Throat, Nose and
Ear Hospital
Introduction
The merging of a clinical services is
to increase Growth, Efficiency and
Capital and most of all to provide a
world class service to the patients
4. The Royal National
Throat, Nose and
Ear Hospital
Case Study : Ophthalmology
Managing the delivery of streamlined pathways
Achieving targets
Information Management
Centralisation of Relationship
5. The Royal National
Throat, Nose and
Ear Hospital
Managing the delivery of streamline pathways
and Information Management
Challenges
• What may work on one site may not
work on another
- Different work methods
- Break down in communication and
information not reaching the right
people
• Changes in time tables for clinicians,
nurses, the MDT as well as support
staff
• Mismatched Infrastructure – medical
records, data protection, IT.
• Resistance/ Adverse reaction to
change
Possible solutions
Allowing flexibility and autonomy
- Sharing best practice across site
- Clear communication lines regular
meetings/ Video conferencing .
• Planning and having clear direction.
• Having an Electronic system that is
accessible to all – consolidating data
to a central point
• Providing training and support to
help manage change
6. The Royal National
Throat, Nose and
Ear Hospital
Centralisation of relationship and
achieving targets
Challenges
• 48-hr triage
• 18-week pathways
• Same level vs subordinate
• Decision making
Possible solutions
• Electronic triaging
• Efficient co-ordination across
sites
• Clear job roles and reviews
• To involve the spoke leaders
7. The Royal National
Throat, Nose and
Ear Hospital
Summary
Clear pathways
Communication
Co-ordination
Sharing
Best practices / Resources
Flexibility
8. The Royal National
Throat, Nose and
Ear Hospital
Framework for Integration
(model by Noblis center for health and Innovation)
Competitiveness Growth Efficiency Capital
Is a function of
↓ ↓ ↓
Institutional Volume and - Expenses + Return on assets
performance Service level (cost/unit x units) (Human +Capital)
↑ ↑ ↑
Performance -Geographic penetration -Labour productivity - Incentive alignment
Drivers -Community linkages -Process Efficiency - Compensation &
-Reputation -Service levels benefits
-Programs and service mix - Capacity management - Information &
-New product & development - Supply chain infrastructure
-Physicians - Care and clinical resource – Plant & Equipment
-Quality and service initiatives management - Real Estate
- Organisational structure
Editor's Notes
Merging of clinical services has its challenges
Having worked at both Hub and spoke the main challenges face included the above
The main downfall of the Hub and spoke model is communication
Communication with one key point of contact may no necessarily be the right person to make the decision and
From Experience decision made at the Hub , may look fine on paper but may not nesarlily work at the spoke sites due to limitations at the sites
For example : Surgery setting – At RFH – changing doctors lists to cover another may work as the equipment, trained nursing staff where as at outreach this is not possible thus making any changes may need input from the local sites and see if it is feasble to have make these changes
The main downfall of the Hub and spoke model is communication
Communication with one key point of contact may no necessarily be the right person to make the decision
Example of theatres in Barnet : not same function as RFH
Clinic mixing : work due to space and shortage of staff : RFH – not at barnet – streamline process such as macular clinics at Barnet
For example : Surgery setting – At RFH – changing doctors lists to cover another may work as the equipment, trained nursing staff where as at outreach this is not possible thus making any changes may need input from the local sites and see if it is feasble to have make these changes
Teams working with a single managerial structure – prioritising and organisation will be to patients benefit
Same terms and conditions for development for staff across all sites
Removal of cross organisational boundaries – more clarity for patients
The main downfall of the Hub and spoke model is communication
Communication with one key point of contact may no necessarily be the right person to make the decision and
From Experience decision made at the Hub , may look fine on paper but may not nesarlily work at the spoke sites due to limitations at the sites
For example : Surgery setting – At RFH – changing doctors lists to cover another may work as the equipment, trained nursing staff where as at outreach this is not possible thus making any changes may need input from the local sites and see if it is feasble to have make these changes
This is an opportunity to have a greater skill pool in work place
More resilience in times of operational pressure , sickness and absence
Team work can be distributed to other sites to meet targets and demand
Use example of Edgware community - works and has a high success rates as it can be done via email and works
18 week pathway – using Edgware or Whittington with more capacity – patient choice and efficient utilisation
Manager at Barnet – making and running the sites automosly , RFH do the same
This is an opportunity to have a greater skill pool in work place
More resilience in times of operational pressure , sickness and absence
Team work can be distributed to other sites to meet targets and demand
Teams working with a single managerial structure – prioritising and organisation will be to patients benefit
Same terms and conditions for development for staff across all sites
Removal of cross organisational boundaries – more clarity for patients
Co-ordination –who/ What where
Clear pathways – process across all sites clear
Communication – with the right people with in the right time frame
Flexibility - to allow elasticity when need arises - to ensure care is not affected
Sharing - best practice in way of work and sharing resources to reduce costs
A model on frame work on integration by Noblis center for Health and innovation - this cover the vast number of challenges on faces when any clinical service is merged and need to be managed in order for the merger to be sucessful
