Why go to A@E with flue

I think it’s a stretch to suggest that there is or even could be any correlation between the culture of quality in the HSE, and the State sector in general, and the Shinto influenced Japanese culture of excellence.

As for Lean and Kaizen (both methods developed by Americans, not Japanese), they require adaptability, decision making at a local level, employee engagement and empowerment and labour flexibility. None of these are present at the required level in the HSE.
 
Purple said:
I think it’s a stretch to suggest that there is or even could be any correlation between the culture of quality in the HSE, and the State sector in general, and the Shinto influenced Japanese culture of excellence.
Click to expand...

We'll both agree there's very little chance of that kind of culture ever permeating the HSE. It would take a seismic shift neither the administrators, unions, nor government want to contemplate. My point in this thread is just because the system is rotten, we shouldn't discourage everyone within trying something that might pay dividends. There are good people working in the system, some are trying to bring about change from within, if we knock them down at every opportunity, things will only get much worse.


The Lean term was coined by John Krafcik in a paper on his experience as a quality engineer with Toyota and TPS. The history of waste elimination/ quality goes back nearly as far as industrialisation itself, but my point was how Japan embraced these after WW2 to very quickly move into a position of dominance.
 
Irish Times:

http://www.irishtimes.com/news/health/new-curbs-on-hse-recruitment-to-be-introduced-1.2526177

New curbs on HSE recruitment to be introduced
Confidential memo by HSE chief Tony O’Brien warns rate of hiring cannot continue

Rise in health service employment
Rise since Dec 2014 by staff group

Care 993
Clerical and administrative 669
HSPC other 660
NCHDs 379
Staff nurse 317
Nurse manager 296
Management 291
Therapists (OT, Physio, SLT) 209
Nurse specialist 128
Consultants 92
Public health nurse 55
Support 46
Ambulance 30
Nursing student 16
Medical other 8


Given the shortages of beds & nurses in hospitals around the country and the long waiting lists in general, does anyone else think that hiring more than TWICE the number of Clerical / Administrative staff compared to nurses makes sense?

Also the numer of nurse managers almost matched the number of staff nurses - could it be inferred that the nurse managers were promotions and the staff numbers were replacements? If so, we have the same number of nurses but more management!

Also, I like to know what HSPC other refers to since it was the 3rd highest ?



Time to really think about the HSE. Bring back the nuns!!!
Firefly




 
I know it well. This is the paper in question. If you applied the same principles to the healthcare industry, or just look at the bottlenecks within the sector in the light of Lean then many of the solutions become obvious, if not easy. It also becomes abundantly clear that money is not the problem.
 
It is not that simple. Flu can be lethal, especially to those with serious underlying medical conditions and sometimes to those who do not.

Already this year, tragically, a 5-year-old boy, who had no underlying medical conditions, has died in Crumlin Hospital from swine flu. Many other children and babies have been hospitalised with the same condition.

Certain flu sufferers may, quite rightly, be referred to A & E by their GPs.

A & Es are reactive. Who knows how many patients will present with whatever conditions on any one day/week/month/year.

In other words, their work is not predictable. They are not making widgets, cars or mobile phones.

Should everyone have attended A & E? Who knows?

To form an opinion, one way or another, one would need and have to start with qualitative statistics from each A & E service.
 
Interesting that Lean / 6 Sigma should be discussed here in the context of the HSEs. For those not familiar with the terms, here are the 7 underlying principles:
  1. Focus on the customer
  2. Identify & understand how the work gets done
  3. Manage, improve & smooth the process flow
  4. Remove Non-Value-Added steps & waste
  5. Manage by fact & reduce variation
  6. Involve & equip the people in the process
  7. Undertake improvement activity in a systematic way
In the case of the HSE no 1. is what needs to happen, ASAP. Anything that diverts from this is a distraction. Rewarding each other with plastic trophies and dummy awards is, as I've said already, a serious distraction from the changes that need to happen and might even lead to staff believing that are doing a great job, just because they can point to a trophy they awarded themselves.

Let me give a simple example of how far removed from customer focus staff in the HSEs are. When nurses get to within 4 or 5 years of retirement age, irrespective of business need, they are automatically placed back on restored duties. The purpose of this is to increase their reckonable salaries for pension purposes. Rostered duty allowances are reckonable as salary for pension purposes, thereby inflating final salary and pension. This does nothing to improve services or patient care and proves that staff and unions use the HSEs as cash cows and have lost sight of their purpose.

Staff at all levels collude in this kind of expensive waste e.g. multiple employees from a single location due to attend a central event will all take their individual cars and charge mileage. The reason this nonsense goes on is because they, staff and "management" are all members of the same unions and no-one can afford to break ranks.

I should point out that I have extensive manufacturing experience and have also worked as a clinician in the Health Boards / HSEs / Service Providers.
 
Good post mathepac.
I have worked as a quality engineer in industry (medical device manufacturing) and previously as a manufacturing engineer. My current role includes new process design and implementation and we apply Lean to just about everything we do.
Buy-in and empowerment of staff is critical. This is a major stumbling block in the protected sectors of the economy as employees think that they deserve a pay increase for any improvements they are part of. In the open sector employees see such improvements as providing a competitive advantage for their employer and therefore an improvement in their job security.
As long as the parasites in the unions prevent major process improvements by attempting to blackmail their employer into diverting resources from patient care into wage increases there is no real prospect of reform.
 
Kaizen/Lean is seen by Unions as an attack on long held , hard fought for practices such as job demarcations , job classifications & seniority rights which if successful would see a return to the days when management exercised full prerogative unimpeded by Union recognition .

I do realise that many would welcome such a scenario but the reality is that such a system is not going to be implemented in the HSE as long as the Unions represent management as well as staff .

Nor , it must be said , has any Irish Government as employer shown any interest in introducing such a system in the public sector - possibly because of the strong adverse reaction it would provoke.
 
Very honest post Deiseblue. I agree and it's a shame because it should result in a better workplace and empowered and therefore satisfied employees. The problem is that the people in charge in the HSE seem to be the ones who need to change most so the main winners could be the "consultants" who spend years trying to work around the Unions.

Enterprise Ireland have an excellent Lean team. I wonder if they, as another state body, could be used here?
 


Lean and 6 Sigma or a combination of both has many guises and is implemented in different ways.

How would you see this put into practice in, say, A & Es?
 
Deise Blue,

Lean and 6 Sigma are used by Ge ,a large American Conglomerate.
They applied lean/6 Sigma on their finance wings , upshot was finance wing bailed out by US government ?
That does not mean lean/6 Sigma are bad but Purple saying 6 sigma/lean may mean (empowered workplace) is putting too much faith in a system.

Simply (in my opinion) most workplace issues comes down to weak management.
To hang blame on Unions is too simplistic.
With no unions ,poor managers would still foul up.
Could it be that in many cases Unions stop poor management , at least that is what history has shown us.
 
Gerry , I totally agree with you .
I am totally of the opinion that Kaizen/Lean disempowers employees & should be resisted at all costs.
I should have clarified that when I stated previously that such a system could not be introduced in the HSE as both management & staff were members of Unions I did not mean that as a criticism rather I see such all encompassing Union membership as desirable.
 
So @Deiseblue do you see the examples I gave as desirable because they are the status quo or do you believe they are even sustainable in the medium term?

Never yet has the big HSE at a corporate level or the other HSEs at operational levels met their budget numbers, either in man-power or monetary terms. Other targets about lead-times, response-times, wait-times are being missed daily, weekly and monthly. They have closed beds in the belief that beds create costs - they don't. Like any service organisation the HSEs' biggest costs are people costs. They cut staff to reduce costs and to meet whole-time equivalent numbers, but cheated and blow more budgets by hiring back the staff they had cut at inflated agency rates and lower productivity levels and still incurred additional man-power costs as the agency staff would not work week-ends or rostered duties.

6 Sigma, 5 Ss, Lean, Kaizen, Quality Circles, JIT, Kanban, Ishikawa Diagrams for problem solving, in fact any technique where the outcome is to maintain the status quo is destined to failure, you have what used to be called a day-one deviation.

A&Es are not fit for purpose for dozens of reasons, they are down-right dangerous places to be but that won't change unless they are designed from the ground up to work for their clients.
 
I have been looking at these A & E statistics.

Are these the latest available?

I note that there were 1,278,522 Emergency Dept attendances in 2012 and that this number is typical for the years displayed – (2003 – 2012).

In 2012 the population was 4.587m. I appreciate that the figure of 1,278,522 includes repeat attendances.

Are there any more granular statistics available on the 1,278,522?

For instance, do we know how many individuals were involved, why did they present, etc.?
 
I've tried the Dept of Health site and it's a nightmare - lots of tables and reports stored as PDFs & XLSs, all at leat 5 years old, all qualified in some way "acute hospitals only, excluding non-residents", or "no numbers available for 200X due to changes in tabulation methods" or "we are no longer responsible for those data, look elsewhere", anything to enable obfuscation.

Interestingly, I did find a report called "eHealth-Strategy-for-Ireland.pdf" which quotes this strategy's purpose as:-

"Bringing improved population wellbeing, health service efficiencies and economic opportunity through the use of technology enabled solutions"

the usual buzz-word stuff which could be prècised as "Saving money and improving health, using IT" which is only seven words long and saves time, money and printing costs.

Unfortunately this whole initiative sounds like PPARS all over again, just bigger, and has identified a dependency on a Deliverable from the Dept of Health the "Individual Health Identity Number" to be used instead of our existing PPSN. At least three other "strategic programmes" designed to replace the PPSN with this "IHIN" have failed but you can't criticise the determination, even if it is misplaced.

This document talks openly about the dismantling of the HSE, but gives no indications as to how many more mini-HSEs will replace it.

I deleted all the "fluff", blank pages and page-sized coloured photos leaving 67 A4 pages of "content" (see above 7-word strategy statement versus their 17). In those 67 pages, work design gets less than half a page, and I quote:

"4.5 Re-designing Work Practices

eHealth deployments by their very nature are disruptive and international experience has shown that their success can be measured by an organisation’s ability to adapt work practices and processes. eHealth needs to be viewed as a process reengineering activity facilitated through the use of information systems rather than a ’pure’ ICT project per se. The distinction here is important, because the decision to utilise eHealth solutions and the consequent planning and execution needs to be based on the recognition of a business need, the understanding and acceptance of any potential change management implications, the identification and provision of the required resources and the establishment of an authoritative governance and project management structure. In addition, the importance of stakeholder engagement and in particular clinical engagement is obvious in order to achieve a successful eHealth project in which full benefits are realised by all parties. Figure 4.2 outlines the key elements insuch an eHealth project.

The importance of process reorganisation and adaptation of work practices must be re-emphasised as failure to do so will result in
an even more confused and costly system than before. Hal Wolf of Kaiser Permanente in the USA (one of the earliest and most successful adapters of eHealth technologies) summarises this as follows;

NT + OO = COO

New Technology + Old Organisation = Costly Old Organisation

Issues such as skills and training of staff therefore are as important as pure technical competency when it comes to integrating eHealth technologies and redesigning work practices and processes."

I think you can understand my scepticism

Hidden in all the flannel and fluff and stuff copied and pasted and quoted from other sources is this gem, this moment of insight around development and delivery:-

"3 Outsource the delivery entity

Outsourcing (through a tender process) of the entire eHealth delivery function to a third party with previous successful experience of implementation.

Pros:

» Decoupled from perceived public scepticism of the Health Services ability to deliver major eHealth initiatives."

No mention found yet of simple, up-to-date, un-massaged stats for A&E specifically but I'll continue looking.
 
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Marian Finucane had a Consultant from St Vincents I think it was on last weekend. He works in both Private and Public.
He said when he's in the Private, he has targets...so may surgeries, so many follow ups. All measured and recorded. Reviews on results with Senior Mgmt.
When he's in the Public, no body chases him. Operations are cancelled at the last minute...staff availability, room/equipment availability. No shows by Patients for consultations etc. And it's left at that. Never seems to be much of a push to improve the system.

The entire Health System is broken and the ongoing patches applied every 5 years by a new Govt are a waste of time, money and resources. The entire system needs to be redesigned on paper...what would an ideal system look like. Then a timetable for implementation set out and if any self-serving/self interest Grouping decide to nuke it, then show them up for the greedy carefree luddites that they are. Yes, there may/would be strikes and a lot of strife but eventually you'll get the 21st century system that is needed. Short term pain for long term gain
 

Hi Mathepac,

I'm having the same difficulty.

The pity of it is that people are probably entering valuable data that is going nowhere.

Even if systems are being changed, information should still be extractable. Surely this data would be necessary for annual reports, governmental briefings, etc., not to mention internal assessment.

Many large organizations, including govenment departments, have IT systems in constant stages of upgrade, which does not impede access to essential information.

I see your point that use of the Individual Health Identity Number seems ridiculous.

I am thinking of situations where people are receiving health care from a combination of the HSE and also from the Social Protection Dept., which uses the PPSN.

And you are right, you have to pick your path through the promotional waffle!
 
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