The Curious Case of… Model 3&2

(adapted from Curious Case of Benjamin Button)

Avilene CaseySDU Liaison Officer

Hon President of IADNAM

Background -Hospital ModelsO Government redesign of acute hospital system –Future Health 2012 – 2015, Small Hospital Framework 2013, Establishment of Hospital Groups 2013

O Health Service Reform programme – move from hospital centric model of care

O Clinical Care Programmes AMP, NSP etc.O National Standards for Safer Better Healthcare –

towards LicencingO HIQA reportsO EU Directive

Rationale for Establishment of Hospital Groups

O Large range acute hospitals operating in relative isolation

O Duplication and fragmentation of resourcesO Difficulty in recruitment and retention of key

clinical staffO Non compliance with EU DirectivesO Inequitable distribution of workload and

resources.(Adapted from Professor John R. Higgins May 2013)

Objectives O Improve the quality of patient careO Improve access to appropriate servicesO Improve cost effectiveness O Improved health outcomes and satisfaction

for patients

Need to create a paradigm shift in the way acute care is managed.

Right staff, Right Skills in the Right Place

The Importance of being a Model 3 or 2

“Now produce your explanation and pray make it improbable.”

― Oscar Wilde, The Importance of Being Earnest

Model ‘sO 9 Model 2O 26 Model 3O 8 Model 4

(reference DoH, AMP, NSP and SDU)

ED Attendances and AdmissionsYTD All Hospitals ED Attendances

166,414

YTD All Hospitals ED Admissions

45,252

Model 4 ED Attendances

70, 557

Model 2&3 ED Attendances

95, 587

Model 4 ED Admissions

19,005 (26.9%)

Model 2&3 ED Admissions

26,247 (27.4%)

Importance of Model 3-2O Improve patient flow across the

continuum of careO They will act as the hub in an integrated

system of primary and hospital careO Deliver faster access increasing volume of

elective services in selected specialitiesO Treat patients at lowest level of

complexity safely, timely, efficient and as close to home as possible

Emerging Focus- Leading care across the

ContinuumO Preventing avoidable

patient admissions/readmissions

O Equipping Patients for long term self management

O Building readmission prevention strategy

O Improving discharge instruction

O Enabling safe transition home or to other sites

O Creating bi-directional patient flow streams

Role of Model 2 HospitalsO Change in health trend showing an increasing

use of day case procedures in all specialitiesO Enable GP and Primary Care teams to support

patients in their own communityO Rehabilitation is a major role of small hospitalsO Health promotion- prevention and managementO Care for differentiated low risk medical/surgical

patientsO Elevating the patient & family experience

Service OpportunitiesO Day Surgery – & 2S – fit but need stayO Ambulatory Care – Chronic Disease management,

assessment of older personsO Medical Services – Clinics e.g. cardiac failure,

Rehab, COPDO Diagnostics Bloods X-Ray endoscopy,

bronchoscopy etc.O Palliative CareO Patient centred care – decision making, needs,

experience

Service opportunities continued

O Collaborative workingO Development of common standards of careO Flexible movement of clinical staffO Robust patient transfer arrangements based on

clinical needO Ambulance bypass, transfer & repatriation

protocols O Entire group expertise and resource realisedO Building a competent engaged workforce

Nursing opportunitiesO Working across sites/boundaries -Nursing

can become the integrationO Nurse led OPD clinics – pre surgery

assessment O Advanced roles - Reframe redesignO Specialist rolesO Engaging the nursing workforceO Preparing graduates for service

ChallengesO Politics – Professional, governmentO CultureO Emotion – societal roleO EducationO Physical/TechnicalO Structure

“You can be as mad as a mad dog at the way things went. You could swear, curse the fates, but when it comes to the end, you have to let go.” – Benjamin Button

Challenges continued O How do you use the experience wisdom and talent

that currently exist in your service in a different way ?

O Development of Competency Frameworks to meet the new service delivery

O Robust assessment skills, O Patient flow requiring a high level of efficiency and

coordination, data interpretationO Discharging – nurse ledO Leadership accountability for performance

Intervention Area Metric National target

2010 2013 Trend

1Assess and avoid admission

% of patients with LOS=0 25% 11.54% 23%

2Short Stay Unit

% of patients with LOS 1-2 days

31% 25.36% 24%

3Efficient Processing of ordinary

patients

% of patients with LOS > 2 days

44% 63.10% 53%

4Complex discharges.

% of patients with LOS >14 days

11% 13.12% 10.8%

Area 4 % BDU of patients with LOS > 30

33% 34.82%

Areas 3 and 4 AvLOS for those staying > 2days

6 -10 days

12.87 12.4

Overall AvLOS for medical patient

5.8 days 8.48 6.94

Acute Medicine KPI Results

Data Source: HIPE, ESRI

© Acute Medicine Programme HSE Ireland

Medical AvLOS for 2009, 2010, 2011, 2012, 2013

7

7.2

7.4

7.6

7.8

8

8.2

8.4

8.6

8.8

9

Jan10

Jan11

Jan12

Jan-13

Time Period

Av

LO

S (

da

ys

)

Data Source: HIPE, ESRI© Acute Medicine Programme HSE Ireland

What nowO Exploration and agreement Locally – front line staff with service intelligence Regionally DON’s within Group/network of

Model 2 & 3 DON’s Hospital Group Governance Structures IADNAM Clinical colleagues - Colleges National – ONMSD, DoH, 3rd level Institutes, NMBI Create a unified national vision and strategy

For what it's worth: it's never too late or, in my case, too early to be whoever you want to be. There's no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it.

Benjamin Button looking back on his life says:

Thank you.