Hospital Governance in a Transitioning Healthcare Environment

1. Hospital Governance in a Transitioning Healthcare Environment

2. Session Outline • An overview of organisational Development Programme in Beaumont Hospital, including some details on our implementation of Clinical Directorates. • A look at the External Environment (in transition) from the perspective of Executive Governance – Clinical & Corporate at hospital management level. • Concluding with a reflection on the challenges/dilemmas for hospital managers.

3. OD Programme • A high level Action plan incorporating strategic and operational developments. • To ensure Beaumont Hospital remains a leading edge healthcare provider. • To create an organisation that is fit for purpose “ie delivery of safe high-quality services. In the OD Programme activities are grouped under five key themes representing a “whole systems” approach to Strategic change and development.

4. Regionalisation Lead Clinical Directors National Strategy of NPRO HIQA Strategies & Governance Academic Health Alliances Department of Health Dept of Finance – An Bord Snip etc

5. Reconfiguring the Hospital – moving from traditional centralised structures to devolved management.The New Structure CorporateOD, HR, Finance, IT,IQS,Medical Admin, Service Planning, Executive Leadership TherapiesAllied Health Professionals, Pharmacy,Medical Physics and Clinical Engineering. FacilitiesPatient Services,Catering,Portering,Security,TSD,Hygiene Directorates HSE DOHC Other Funders HIQA Centres of Excellence National Strategies Patients/ Families GeneralPublic Cancer Strategy Care of Older People Medicine * Neurosciences, Cochlear Implant and ENT * Nephrology, Urology & Transplantation * Critical Care & Anaesthetics Surgery Radiology Laboratory Medicine Services Influencers

6. Our ApproachThings that made a difference! • Mandated in the Hospital Strategy 2006-2010. • Creating of the OD Department in 2007. • Changes in the external environment ie new Consultant contract etc. • A lot of research of best practices nationally and internationally – by Senior Executive, Heads of Departments, Heads of Professions, Clinicians etc. • Management Executive direct engagement with speciality teams over a 3 year period prior to and during the design phase.

7. Wide scale consultation with staff at all levels in the design and implementation. • Specific consultation with the Medical Executive, Medical Board and Cogwheels. • High Level Steering Group comprising of Senior Executive and Medical Executive members. • Project reporting into a sub-committee of the Hospital Board which provided support and authorisation to proceed at times when the external environment was confusing. • Engagement with Trade Unions regularly re design and implementation. • Utilising a structured project management approach.

8. Configuring the groupings (Directorates) closely around existing Cogwheels and Nursing Divisions. • Developed a plan for the provision of corporate services and facilities. • Designed a model for interfaces between centralised services and the Directorates (Relationship Managers). • Hospital wide communications strategy and plan. • Ongoing management and staff education and development events. • Ongoing focus on process improvements/re-engineering ie PACS, LIMS etc.

9. A View of the External Environment

10. Voluntary Hospital Governance • CEO is accountable to Hospital Board for running of the hospital • Day to day operations • Meeting targets • Working within budget • Ensuring patient safety • Developing expanding services • Corporate & Clinical Governance

11. HSE Management Structures • CEO reports through Network Manager, Regional Manager and various Corporate HSE Functions. • Delivering the Service Plan • Meet Healthstat targets • Liaise with the community • Co-operate with wider Health Systems initiatives Failure results in financial penalties, restricted development funding etc. Incentives ie agree on A/E waiting times = minor capital grant Sanctions ie red on A/E wait times = considerations to close down A/E departments

12. HIQA Governance Hospital Board and CEO accountable for “Patient Safety Framework” compliance with all the standards etc. Failure results in licensing implications!

13. National Strategies – Governance/Accountability CEO responsible for implementing the strategies/ programmes. Governance very unclear for hospital management and for staff assigned to the programmes. Failure results in threats of withdrawal of programmes, removal of Centre of Excellence status etc.

14. National Clinical Director • Works through Lead Clinical Director and other Clinical Directors and Consultants. • CEO and hospital management accountability undefined. Department of Finance • Decide on funding allocation – no accountability for the implications/impact on services

15. AHC’s • This involves combining academic and service provider institutions and the governance implications that go with this. • In overall terms they are some ways off, however, if the plan is to commence with merging/combining management structures across hospital sites it will be important to have some vision on how the overall entity might operate.

16. Dilemmas/Challenges for hospital management • The mind map demonstrates the minefield of structures and competing priorities. • This is compounded by the transitory state of structures ie: • Will the internal structures that we and other hospitals have created interface with the emerging external structures? • How will hospital services be integrated with PCC? • What will regionalisation look like? What’s in – what’s out of each region?

17. Will the “new models” embrace all healthcare providers, (private, public, voluntary etc) in a region. • Will the current AHC models fit with the eventual regionalised models? • How do CEO’s/Hospital Mangers influence future decisions? • How can we ensure that what is being designed results in real improvements in services to patients (all patients not just these in high risk categories?)