background image
T
he Hospital Network session featured expert
speakers all of whom have key roles in the
development of Networks Professor John R.
Higgins, Professor of Obstetrics & Gynaecology and
Head of College of Medicine & Health, University
College Cork; Mr Ian Carter, National Director,
Acute Hospitals, HSE; Professor Pierce Grace, Chief Clinical
Director, UL Hospitals, Limerick; and Professor Cathal Kelly,
CEO/Registrar, RCSI.
NETWORK RATIONALE AND OBJECTIVES
Professor Higgins who chaired the group carrying out the exploratory
work which led to the new configuration of Irish hospitals into six
hospital groups, opened the session. He first explained the rationale
for the new network approach: "A large number of acute hospitals
operate in relative isolation leading to duplication and fragmentation
of resources. There are associated difficulties in recruitment and
retention of key clinical staff. The end result is an inequitable
distribution of workload and resources and a lack of compliance with
EU directives."
In contrast, he outlined a vision for a transformed system: "The
formation of hospital groups, which will transition to independent
hospital trusts, will change how hospitals relate to each other and how
they integrate with the academic sector." Over time, the new approach
will deliver:
higher quality services;
more consistent standards of care;
more consistent access to care;
stronger leadership; and
greater integration between the healthcare agenda and teaching,
training and research.
The Academic Health Centre (AHC) Model has been chosen to
ensure rigorous governance, he noted: "Hospital groups can utilise
an AHC model to provide overarching governance structures for the
relationship between hospitals within a group and their relationship
to their primary academic partner. Within the AHC model, any
proposed overarching board must meet recommended criteria."
Professor Higgins listed the criteria which include:
no combination of chair and CEO roles;
a quality improvement framework; and,
full implementation of the governance recommendations arising
out of the HIQA Tallaght Hospital Investigation Report.
"The intention is that well functioning Hospital Groups will transition
to Hospital Trusts," he added.
In conclusion, he outlined the key phases of the network
implementation plan:
an initial meeting with each new Hospital Group;
establishment of a Hospital Groups Implementation Team and a
Hospital Groups Steering Group;
appointment of chairperson for each Group;
appointment of Group CEOs;
frontline information and consultation at all acute hospitals.
A COMPLEX, ADAPTIVE SYSTEM
Mr Carter, National Director, Acute Hospitals, HSE outlined the
range of challenges facing hospitals, beginning with accessibility. He
commented: "While access has improved, the improvements remain
inconsistent. There is a requirement to solve the problem, once and
for all, and move to a stable improved performance. More top-down
direction is unlikely to deliver the necessary improvements. There is
a need for the development of sustainable local initiatives at specific
hospitals and the Hospital Group structure presents significant
opportunities to stimulate such developments."
Another factor is the requirement to achieve both fiscal and whole
time equivalent (WTE) reduction driven by fiscal imperative, as
opposed to a calculated workforce reduction based on known
inefficiency. "It is important that we take steps to protect hospitals
against potential local risk issues arising from the pursuit of the
fiscal and WTE reductions. We must develop and support the local
Hospital Control Functions to ensure the maintenance of appropriate
local capabilities to deliver services."
Underlying the many challenges is the fact that health delivery is a
complex, adaptive system, he said. "The system is not linear, it is very
dynamic and, generally, there is no one single point of control with
20
HOSPITAL NETWORK
DEVELOPMENT
THE QUEST FOR MEANINGFUL CHANGE
NETWORKS WILL THEY AFFECT CHANGE? THIS WAS THE TITLE
OF SESSION 2 IN NOVEMBER'S MILLIN SYMPOSIUM, WHICH
FOCUSED ON PROGRESS IN DEVELOPING IMPLEMENTATION OF
THE HOSPITAL NETWORK CONCEPT
Surgical_Scope_ISSUE2.indd 20
30/01/2014 15:39