St Luke’s Symposium November 2010 National Clinical Programmes Dr Barry White Director of Quality & Clinical Care HSE 1.

St Luke’s Symposium November 2010St Luke’s Symposium November 2010

National Clinical Programmes

Dr Barry WhiteDirector of Quality & Clinical Care

HSE

1


How does the Directorate link to other HSE Management

functions? The Directorate of Quality and clinical care is one of a number of integrated HSE management trams design to

deliver an efficient and effective patient centric Health Service

2

PLAN IMPROVE

Define the way clinical services should

be delivered, resourced & measured

Objective

Leadership responsibility

Co-ordinate the development ofService Plan

Management Plans

Mange the allocation of

resources

Identification of service

improvement solutions

Corporate Planning & Control Processes

Directorate(CPCP)

Quality & Clinical Care Directorate

(DQCC)

Integrated Services Division

(ISD)

Tactical – ISDStrategic – DQCC

Operational – Infrastructure

Monitor & report performance

against targets and plans

Monitor – ISDReport – CPCP

Key Management processes

Enabling management processes

Human Resource Management

Financial Management

Infrastructure & IT Management

Communications

DEFINE MANAGE MONITOR& REPORT

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Mission

Better care and better use of resources


3 key issues

• Clinical leadership for subject matter expertise and credibility (public and clinical)

• Standardised care (save lives and saves money)

• Programmatic approach

4


What is the mission of the Directorate of Quality & Clinical

Care? Better care and better use of resources

• If patients get the right treatment we can save lives and money• 70% of healthcare spend is on 6 chronic diseases (with 80% of this on patients

with >3 chronic diseases)• 70% of deaths are associated with these chronic diseases• Chronic disease management is delivered in an unstructured manner and 50% of

patients do not receive the right treatment• If patients received the right treatment this would save 25%-40% of healthcare

spend• E.g. Stroke in Ireland • Sustainable healthcare improvements are clinically led (KP, Finland Asthma etc)• A structured and clinically led approach to chronic disease management will

improve outcomes and save money


Why take a programmatic approach to change?

The advantages of developing chronic disease management programs are:

– Structured approach to disease management to ensure patients gets the right treatment

– Change is led by experienced clinicians with expertise in disease and service delivery.

– Generates clinical buy-in and ownership from the start. Also provides opportunity for bottom-up and top down change by engaging Colleges and professional bodies.

– Enables greater organisational responsiveness i.e. frontline staff can access the top of the organisation in one step via the national lead.

– Provides a sustained focus

– The appointment of Prof. Keane as the Director of the National Cancer Control Programme (NCCP), demonstrates the importance of having an expert in the relevant clinical area to engage with evidence to the public, media, politicians and other clinicians.

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Overall principles

• Set goals that achieve gains in cost, quality, access and compliance• Set goals that are simple and meaningful – e.g. prevent 300 stroke

deaths • Target what is achievable • Target areas that can sustainable short term gains• Nationalise existing local good practice - do not reinvent the wheel • Ensure local ownership (authority, accountability and responsibility)• Ensure patient involvement• Embed data at the centre of all assessments and decisions• Detailed implementation and communication plans


What are the stages of the standardised approach to managing

change?

Initiate program

Scope the program

Set Goals

Measure & analyse

performance

Validate solutions

Detailed solution design

Implement solutions

Sustain & improve

performance

1 2 3 4 5 6 7 8

1 2 3 4

Define key

issues & solutions

Checkpoints with the Program Advisory Group, the Director of Quality & Clinical Care and Steering group

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Programs & leads

Medication Management

- PM Mairead Gleeson 4. Acute Hospital Services

To be appointed

Paediatrics

Rehab


Overall principles 1. Clinician led change supported by multidisciplinary teams

2. Patient involvement

3. Programmatic approach focused on implementation

4. Set quality, access & cost goals that are meaningful – e.g. prevent 300 stroke deaths

5. Nationalise existing local best practice

6. Ensure local ownership

How success will be assessed : 5% of marks for the solution 95% for successful implementation





Key Acute Medicine features of the Blue Print

• Acute Medical Units, Acute Medical Assessment Units and Medical Assessment Units

• New working practices/continuous presence

• National Early Warning Score

• Rapid access to out-patients

• Navigation hub/bed bureau and Case Manager

• Retrieval service

• Hospital models

• Metrics

• New approach to education, training and development

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Key Achievements of Programmes to date

1. Establish programme teams, governance structures and objectives2. Detailed solution design phase for Heart failure, COPD, epilepsy, Diabetes,

Asthma, Stroke and Acute Medicine 3. Guidelines, Bundles, Models of care complete for above4. Design complete and implementation commenced neurology and

dermatology OPD5. Agreement of Avlos / Day of Surgery & Day Surgery Rates – Roll out 20116. Productive theatre – 5 Sites commenced 7. Surgical and Critical Care Audit implementation planning underway8. Patient information website – 2011 9. Blue print for the future


Heart Failure

• Prevent 2000 heart failure exacerbations requiring admission per year

• Every appropriate patient admitted to hospital with heart failure has access to structured heart failure programme

• Save 200 beds per year• ROI 3:1 in 3 years• Investment involves redeployment of existing nursing staff

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Epilepsy

• Convert 8000 patients to being seizure free• Save one life per week • All patients have access to structured epilepsy programme• Save 60 beds• ROI 3:1 in 3 yrs• Investment requires redeployment of existing staff

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Summary

• Major change in clinical leadership and role of Colleges has been implemented

• Programmes rapidly progressing• Solutions identified • Excellent clinical engagement (doctors, nurses, and Therapists)• Wide stakeholder buy in (Colleges, Nursing, Therapists, HSE SMT, HSE

Board, DOHC, Patient groups, Unions) • Integration underway into single plan• Major financial cutbacks underway• Increasing need for radical change which needs to be clinician led• Enough talking – time for action

St Luke’s Symposium November 2010 National Clinical Programmes Dr Barry White Director of Quality & Clinical Care HSE 1.

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