FRONTLINE PERSONNEL DISENFRANCHISED AND IGNORED – IRISH HEALTHCARE
Many of the frontline staff working in the Irish health service feel disenfranchised and ignored by key decision-makers and can make a far greater contribution to service delivery and reform. That’s according to Joe Aherne, co-editor of an international healthcare efficiency book recently published and CEO of Leading Edge Group who work with healthcare providers in the USA, Canada, UK and Ireland.
Launching "Applying Lean in Healthcare: A Collection of International Case Studies" at the Royal College of Physicians of Ireland, Dr James Reilly TD, Fine Gael Health Spokesperson, said: “Anything which can bring increased efficiency to the health service has to be of interest. ‘Lean’ thinking has been used widely in the car industry and has been applied successfully to healthcare systems.
“I believe the book published by CRC Press will be keenly studied by anyone who would like to see our health services eliminate waste on the management and organization side so that frontline services can be protected and delivered efficiently.”
For his part, Mr. Aherne said: “Our experience of staff working in the Irish healthcare system is of a caring and committed community who are not empowered or given the freedom to make the positive changes they see are required. We need to recognize the talents and contributions of all members of staff – those in support positions such as administration, catering, hygiene, laundry, management and transport as well as clinical professionals.
“At the moment, staff and patients feel disempowered by the decision-making process. There is a real concern that the patient is no longer the central consideration in these decisions with financial and other performance targets to the fore. Skilled and experienced people within the Health Service Executive could make a real impact on patient outcomes but only if they are given the opportunity. This can be done alongside tackling the cost of care delivery – the two are not and cannot be mutually exclusive. Errors and waste can sometimes rival actual care in terms of generating costs in the health service.
“The primary objective in healthcare is that every single patient receives the best possible care, every single time. While it originated in manufacturing, Lean in healthcare can make a tremendous contribution to reaching this goal. Lean is all about increasing patient satisfaction through - for example - providing better care without delay; decreasing length of stays; releasing in-patient bed days; eliminating unnecessary x-rays and fundamentally improving staff morale.”
Mr. Aherne, whose company has offices in Cork and Toronto, added: “Frontline healthcare staff are in the best positions to initiate, implement and achieve the type of improvements that deliver savings and – more importantly – improve the overall patient experience and outcome.
“Healthcare organizations – whether in the public or private sector – need to empower these frontline staff and ensure they have the appropriate knowledge and expertise to make the necessary changes and then give them the responsibility and opportunity to implement reforms. In Ireland, frontline healthcare personnel have been involved in external management consulting projects but have never been asked to implement the recommendations that these exercises generate. Some have not even seen the detailed reports they inputted to. As a result, they are extremely demoralized at the lack of progress being made in Irish hospitals.
“I have personally spoken to these people and they articulate a number of changes that should and could be made within 24-36 months. These include treating day care surgery as the norm for elective surgery, releasing thousands of in-patient beds each year; managing variation in the patient admission process could significantly cut the number of operations cancelled each year for non-clinical reasons; applying a uniform approach to care for people with long-term conditions could prevent thousands of emergency admissions to hospitals and re-designing staff roles, rostering and responsibilities in line with efficient patient pathways could free up GP/consultant time and create a significant number of extra patient interactions per week.”
Mr Aherne who said his company are keen to apply their overseas experience – especially in the Canadian healthcare system - more widely in Ireland added that incoming Health Service Executive (HSE) chief executive Cathal Magee who takes up the role in September will need to draw on his considerable business transformation and human resources experience to deliver real and lasting change.
“There’s a huge prize to be achieved here – the double win of better patient outcomes and increased efficiency delivering cost savings. A June 2007 report from the U.S. Department of Health and Human Services Office of Inspector General found 35% of consecutive stay sequences in US hospitals were associated with quality of care problems and/or fragmentation of services – costing Medicare US$4.5 billion in 2004. Similarly, 11 per cent of individual stays within consecutive stay sequences involved problems with quality of care, admissions, treatments or discharges - costing Medicare US$1.4 billion.”
In his foreword to Applying Lean in Healthcare: A Collection of International Case Studies, Dr Jeffrey Clothier, Associate Professor, University of Arkansas for Medical Sciences, said: “Systems and processes need to be streamlined to fully support the delivery of high quality care. Commitment and support for any Lean initiative needs to not only come from top healthcare management but, even more critically, from the ‘bottom up’ for implementation. Decision making and system development need to be pushed down to the lowest levels of any healthcare organization.”
