Hospital Trolleys

Leper said:
Let's keep the discussion to the truth folks.
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I don't like your implication that I'm lying.

I recently re-read a book from about ten years ago and this excerpt leapt out at me:

"Working in medical care has an almost irresistible tendency to numb practitioners to the realisation that they are treating and tending individuals who are just like themselves. Many claim that they have to dissociate themselves from their feelings if they are to function in the wards, which is plainly not the case. There is more to good care than ethical principles and staff training. It also requires an organisation that accords priority to and accordingly finds room for empathy and humanity without any loss of professional standards. I have seen many places where this has been achieved. It is very much a matter of wanting and being sufficiently courageous to break away from ingrained attitudes. An organisation in which truly humane care is not feasible is a bad organisation."*

The HSE by that definition is a bad organisaton, serving not the needs of the client but the greed of the employees as evidenced by my personal experience and observation of custom and practice in a Health Board and one of the HSEs.

*Psychoses, An Integrative Perspective
First published 2006 by Routledge, 27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USA and Canada by Routledge, 270 Madison Avenue, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group
Originally published in Swedish as Psykoser: Ett integrerat perspektiv by Natur och Kultur, 2000, 2004 © Johan Cullberg and Borkförlaget Natur och Kultur, Sweden
Translation © Johan Cullberg and ISPS Copyright © 2006 Johan Cullberg

And of course we don't need more nurses, we need the nurses we have to do the correct work as defined by client need.
 
Leper said:
I reckon the failure to have PPARS installed was a huge mistake costing millions to the taxpayer.
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Absolutely, €200m in direct costs and further large costs in terms of not gaining the expected efficiencies. Probably the single biggest ever cock-up in the history of the public service.


It appears to me that the blame lies with the nexus of incompetent management and inflexible unions. A system can only be computerised if there is a coherent system in place. In fact health service pay has many overlapping and contradictory provisions, management/unions were unable/unwilling to resolve these, hence the system could not be automated. That's my reason for blaming the actors in the health system. Why do you think it was Deloitte's fault
 
We have less beds , cure the less beds and hay presto ! = less trollies.
From what I read we should have 2000 more beds.

I tire of the union bashing , if the unions were the REAL issue ,they would have closed the Hospitals years ago .
I tire of management bashing , I really think they too try their best.

Surely the BIG issue is the refusal of our 4 yearly cycle of government that refuses to grasp and enact a longer term vision for our health services.
Surely another issue is our (love) affair with the latest genuinely sad case , and our refusal to accept that Health care must be rationed to help the many and not to highlight those more extreme type cases.(sad though they are)

Hard decisions need to be made , and made in the interests of the majority , and made in a reasoned manner that is fair..
 
Leper said:
Good Man ! there, Leo. A person shows up at a Garda Station and reports that he/she has been raped and the Gardaí tell 'em to go home and focus on cleaning up the bedroom which will improve his/her life.
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That makes no sense whatsoever....in any context. Care to explain how it's appropriate to what I said?
 
Gerry Canning said:
We have less beds , cure the less beds and hay presto ! = less trollies.
From what I read we should have 2000 more beds.
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Reducing the ~700 delayed discharge number would go a long way towards addressing that issue.
 
Gerry Canning said:
We have less beds , cure the less beds and hay presto ! = less trollies.
From what I read we should have 2000 more beds.
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We have the same amount as the UK and more than Sweden, New Zealand and Canada.
With such a young population we should need less than most. Perhaps there should be more but I would be very surprised if that solved the issue of structural inefficiency which is at the heart of all of this.

Unlike most other countries we do not count beds in Private hospitals in our statistics, except for psychiatric beds where private beds are counted. In other words we under report the number of hospital beds per head of population. The type of bed is also important but instead we concentrate on meaningless headline figures and emotive personal stories. It's tabloid journalism from our TV stations and tabloid politics from our politicians and Union leaders.
 
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This is totally wrong and it's also unfair on a major company. Groupe Bull Ireland was awarded a contract for implementation of the system at a fixed price cost of just over 9 million euros. Two years into the project the basis of the contract was disputed and was subsequently brought to a conclusion. Then rather than continue with a single system as originally envisaged the project was changed by the health boards to meet each health agency's individual requirements. At this stage Deloitte was brought in on a 'time & materials' basis, despite a recommendation that a third party scope up the system before further contracts were made to ensure it represented value for money. This recommendation was not acted upon. Things then went from bad to worse and you can read all about the litany of disasters in the C&AG's VfM report on PPARS http://audgen.gov.ie/documents/vfmreports/VFM_51_PPARS_Report.pdf.
 
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I have looked at the Comptroller and Auditor General's report linked by PMU above. From page 9 in the summary, it identifies features that had a bearing on the outcome. The bits in italics are mine.

  • A failure to develop a clear vision of what strategic human resource management actually meant for the health service as a whole and for its individual operational units.

    We don't know what we want.

  • An urgent need in the Department of Health and Children (the Department) for accurate information on health service employee numbers and pay costings and a consequent desire to see the system implemented as speedily as possible.

    We dont know how many people we employ or what we pay them

  • A complex governance structure defined by a consensus style of decision-making.

    The nexus of incompetent management and inflexible unions

  • Substantial variations in pay and conditions, organisation structures, cultures and processes which existed between and within agencies, the full extent of which was not known before the commencement of the project.

    We still don't know what we pay our employees.

  • The lack of readiness in the health agencies to adopt the change management agenda.

    The nexus of incompetent management and inflexible unions
  • An inability to definitively ‘freeze’ the business blueprint or business requirements at a particular point in time in accordance with best practice.

    The nexus of incompetent management and inflexible unions cannot afford to let the project succeed

  • A failure to comprehensively follow through on its pilot site implementation strategy before advancing with the roll out to other HSE areas.

    The nexus of incompetent management and inflexible unions cannot afford to let the project succeed

    Leper this was clearly a failure of the public sector and until the problems behind it are admitted and rectified the health system will continue to be dysfunctional,
 
I also read this report and found this this excerpt from page 11 and 12 interesting.

"Governance of the Project

The examination found that, while nominally there was a single responsible owner for the project in the 'lead CEO', this person did not have the power to make and enforce decisions across the range of autonomous agencies.

Likewise, neither the National Project Director nor the National Project Team had the authority to direct when or how the implementations would take place in the individual agencies.

In fact, there was evidence of a lack of ‘buy-in’ to the project in some agencies. Moreover, decision-making was cumbersome due to the size and composition of the National Project Board. Difficulty was experienced in getting agreement on binding decisions with members often unsure of their authorisation to make decisions.

This was further exacerbated by the often patchy pattern of attendance and the frequent changes to personnel attending board meetings.

In addition, several factors, some of which relate to the fact that 2005 was a year of significant change in the health sector generally, were identified as having contributed to the less than satisfactory outcome on the project to date.

These included a void in decision making caused by an uncertainty among senior management of their future roles and authority with the health service and, at agency level, a shift in project sponsorship and frequent changes in team leadership." [Emphasis mine]

I think that timing greatly contributed to the failure of this project.

The health boards had just been amalgamated, with all of the fallout and initial chaos that would have entailed.

In fact, it was probably the worst time to introduce PPARS.

However, that was then.

There should be no reason why it cannot be fully rolled out today.
 
I would argue that the reasons for failure and the reason for not restarting the project are encapsulated in the last sentence in the first paragraph of the report "Hence, the PPARS project involved much more than the implementation of a computer system – it was part of a change management drive." which is always a problem and why the expected benefits of ERP systems never materialise.

The rules are simple
  1. Understand/define/clarify the purpose of the organisation
  2. define and design the work needed to deliver on the purpose
  3. design the organisation needed to do the work
  4. Automate/systemise in support of the work.
PPARS started at 4 and expected the improvements that only the preceding 3 steps could deliver.

The project team were destined to fail from day 1. The report said they had responsibility without authority. The project team(s) should have refused their brief. If they had known more about OD/change management or technology, they'd have known spectacular failure would be the only outcome.

In the 80's I was interviewed by a bunch of consultants to head a team who were going to "implement MRP" (small ERP!!) in Waterford glass. I predicted that the project would fail and disengaged from the interview process.
 
Wow! - When I turned on my lap-top a few minutes ago, I noticed 6 Alerts which probably need reply from me. A personal record, and I will answer each in the next few days. Please bear with me as I have no access to fora such as this during working hours.

. . . and there was that sentence in one of Mathepac's posts:- "I don't like your implication that I'm lying."

I'll address Mathepac's post as a matter of priority today or tomorrow because I never implied that anybody was lying. Furthermore, I will point out some of his untruths regarding sick leave "perks" etc and I will have references to back up the full truth as presented by me.
 
Excellent post.
Hard data is the enemy of incompetent management and inefficient work practices. It strikes me that it was in nobody's interest within the Health Service for the project to work at it would have highlighted true pay levels and been an excellent vehicle for looking at process flows and doing good value stream mapping. The only people who would have benefited from that would have been the sick and vulnerable and they have no voice within the Health Service.
 
Purple said. The only people who would have benefited from that would have been the sick and the vulnerable should also have included the people in the Health Service directly looking after the sick and Vulnerable .
 
jjm2016 said:
Purple said. The only people who would have benefited from that would have been the sick and the vulnerable should also have included the people in the Health Service directly looking after the sick and Vulnerable .
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Then why do they resist change? An efficient Health Service would mean fewer slackers and far less restrictive work practices. Demarcation is a sacred cow for the Unions. There is no way they would allow efficiency and flexible work practices as it would mean many of their members losing their jobs. The staff who see the benefits and would support the changes are not going to oppose the Unions as they would be the target for Union bullying and exclusion.
 
Not so sure you are correct Purple .There was a time when Nurses ran the hospitals .There would be no trolley Problem today and the cost of running the HSE would be a lot less Today if Nurses had more of a say.The busy fools who don't Add Value are a bigger problem than the so called slackers.
 
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jjm2016 said:
Not so sure you are correct Purple .There was a time when Nurses ran the hospitals .There would be no trolley Problem today and the cost of running the HSE would be a lot less Today in Nurses had more of a say.
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Really? What makes you think that?
There was a time when religious orders ran hospitals and nurses were kept in line by the Nuns. They cleaned up minor messes, took blood, monitored antibiotics, made beds etc. and the place was clean and tidy. Now there is no such oversight and the hospitals are rife with MRSA.
 
Check your so called facts and come back and correct Lots of Hospitals were run by Nurses (Matrons)
 
jjm2016 said:
Check your so called facts and come back and correct Lots of Hospitals were run by Nurses (Matrons)
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The Mater Hospital, St. Vincent’s Hospital, Temple Street, The National Rehabilitation Centre, St. Michaels Hospital, Crumlin Children’s Hospital, Holles Street Maternity Hospital, Lourdes Hospital in Drogheda, St. James’s Hospital etc. were all run by religious orders. I don't know about Cork or Galway etc but I presume they are similar. Most are still owned by trusts which are controlled by those Orders but run by the State (the worst of both worlds).
What other facts are you looking for?
 
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