In the current economic climate, the acute sector must reduce its costs in order to deliver the agreed level of activity within the resources available to it. In terms of service delivery, we must concentrate on getting the best possible services for patients from the budgets available to us. This means we need to focus on how beds are used, on the throughput of patients, on reducing length of stay to international norms and on having as many procedures as possible carried out as day cases rather than inpatient work, thus maximising also the efficient usage of operating theatre facilities.
Performance management by hospitals will be measured against a scorecard based on access, quality and finance. This scorecard is part of the HSE’s Service Plan for 2012. I will set the access targets. Quality targets will be determined by the acute medicine programme, which was devised as part of the HSE’s Clinical Programmes: this sets the standards and operational guidelines (including clinical care pathways, discharge planning, staffing, rosters) for managing and delivering acute medicine in hospitals. Its implementation is essential to the success of the SDU as it sets the standards and clinical performance against which the hospital is measured. Finance targets will be determined as the ability of the hospital, and later of Hospital Groups, to remain within budget.
Performance management of hospitals, and later of Hospital Groups, against the financial, access and quality indicators, will be based on the CompStat (Comparative Statistics) management performance approach used in the New York Police Department. This combines monthly data across a series of metrics on hospital performance with monthly performance management and review meetings attended by area and hospital senior management.
Scheduled Care
The SDU Scheduled Care Team was tasked with improving access to elective surgery and lowering waiting lists. There have been significant achievements in Scheduled Care since July 2011 when the SDU was formed.
Inpatient and daycase surgery
- Overall waiting list numbers have decreased from 56, 020 to 51, 955, a drop of 7%
- The number of adults having to wait more than 12 months is down from 2,732 to 408, a drop of 85%
- The number of adults having to wait more than 9 months is down from 6,277 to 2,342, a drop of 63%
- The number of children having to wait > 20 weeks is down from 1,712 to 670 a decrease of 61%
GI endoscopy
The SDU began to tackle long waits for routine GI endoscopy services (i.e. scopes) in May 2012 and:
- Since May 2012 overall waiting list numbers for scopes have decreased from 13,349 to 8, 904, a drop of 33%
- Those having to wait > 3 months (the target for 2012) have decreased from 5,062 to 1,711, a drop of 66%
Outpatients
The initial priority for the SDU was trolley waits and daycases. It has now begun to work on improving access to outpatient services. The SDU and NTPF are on trajectory to take over the reporting of outpatient waiting times from the HSE from Oct 2012.
For the first time individual patient level waiting time data will be available at national level where data will be automatically extracted from all hospitals providing an outpatient service in the same format on a weekly basis. This is a major achievement by the SDU / NTPF in overcoming huge IT incompatability, data quality and other resource issues.
The next step will be to reform the delivery of outpatient services in hospitals, critically examining processes and identifying areas for improved efficiency.
Unscheduled Care
The SDU was tasked with improving access to emergency care. Very significant progress has been made with the result that for significant numbers of patients, the experience in our EDs has been markedly improved.
- The number of patients waiting on trolleys in EDs has reduced by 22% from January to September, compared to the same period last year (or 13,450 fewer patients)
- The number of patients waiting on trolleys has fallen from a record of 569 on 5 January 2011 to 144 on 26 October 2012
- The 30 day moving average (average number of trolleys over 30 days) has fallen by 35% in 12 months, from 302 on 5 September 2011 to 197 on 7 September 2012
- The SDU’s focus in relation to unscheduled care is now moving to patient journey time (attendance to admission/discharge) with that aim that 95% of ED attendees are discharged or admitted within 6 hours of registration and nobody waits more than 9 hours
- The SDU is working intensively to develop best practice hospital sites for patient pathways through unscheduled care.
With regard to a possible reward system, the principle of rewarding good hospital performance is one that I would generally endorse. Hospital budget allocations for 2013 are being carefully considered and I may consider some type of reward system within that context.
