Why go to A@E with flue

I'm reminded of the time Gerry Robinson (Sir Gerry) looked at a small bit of the NHS to try to understand its brokenness. While some initiatives went nowhere, he looked at a surgical clinic that seemed to have longer delays and wait-times than seemed appropriate. He discovered that an operating theatre only opened for business from Monday to Thursday. No-one could explain why it didn't operate to a 5-days-per-week schedule like others. With agreement from surgeons, nurses, admin etc they started using this expensive facility to it's full capacity. Suddenly wait-times reduced, delays disappeared and overall there was less stress and frustration in the system as patients got treatment sooner. It made for good telly at the time (I thought).

There's a lot to be said for the stranger's eye, the naive view. On the other hand the HSEs seem to have free rein to continue navel-gazing.
 
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Valuable Data , Hmn!

Statistically, piracy increased since we saw global warming , ergo Global Warming is a big cause of piracy.??
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Problems are cured by people with the will to continue to challenge those small narks that build up into waffle .
The issue is, will the system support challengers ?

Maybe the idea of putting in a Health Czar for 10 years to make implementable/fast decisions could cut through the layers ?
 
Sophrosyne said:
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?
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I don't know enough about the specific needs but I have see the success they bring in organisations. Many small and inexpensive changes can add up to a major improvement in overall outcomes. There is rarely one big "silver bullet" solution to organisational problems. The big fix is in fact usually lots of small fixes. The best people to identify and implement those are the people who work there. That should then inform an overall cultural change. The prerequisites are a workforce who wants to be empowered and a management which is competent and confident enough to listen and accept that other people might have the best ideas.
If unions think that it will make things worse for their members then they don't understand it. If anyone things that the outcome is just to tweak a broken system them they don't understand it either.
 
Gerry Canning said:
Valuable Data , Hmn!

Statistically, piracy increased since we saw global warming , ergo Global Warming is a big cause of piracy.??
..........................................................................................................................................
Problems are cured by people with the will to continue to challenge those small narks that build up into waffle .
The issue is, will the system support challengers ?

Maybe the idea of putting in a Health Czar for 10 years to make implementable/fast decisions could cut through the layers ?
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I don’t understand your point Gerry. Are you saying that in a huge country-wide organization, such as the HSE, that data is unnecessary?
 
Purple said:
I don't know enough about the specific needs but I have see the success they bring in organisations. Many small and inexpensive changes can add up to a major improvement in overall outcomes. There is rarely one big "silver bullet" solution to organisational problems. The big fix is in fact usually lots of small fixes. The best people to identify and implement those are the people who work there. That should then inform an overall cultural change. The prerequisites are a workforce who wants to be empowered and a management which is competent and confident enough to listen and accept that other people might have the best ideas.
If unions think that it will make things worse for their members then they don't understand it. If anyone things that the outcome is just to tweak a broken system them they don't understand it either.
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Finally, a post that is somewhat on the money. (The likes of Lean and Sigma have well been used up over and over). When everything else is failing, ask all the guys who are on the spot. I mean all the guys including receptionists, clerical, medical, physio, nursing, attendant, security, porters, care assistants etc. And if workable solutions can be found, then even reward them and not with plastic trophies or A4 printed fill-in-the-blank certificates.
 
Leper said:
Finally, a post that is somewhat on the money. (The likes of Lean and Sigma have well been used up over and over). When everything else is failing, ask all the guys who are on the spot. I mean all the guys including receptionists, clerical, medical, physio, nursing, attendant, security, porters, care assistants etc. And if workable solutions can be found, then even reward them and not with plastic trophies or A4 printed fill-in-the-blank certificates.
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Exactly. So something like the Staff Excellence Awards that accepts input from all staff is perfect in this regard. Rewards high achievement and publicises their work internally helping to set standards. It's certainly a very long way from instilling a culture of continuous improvement, but there are so many archaic practices to overcome without a seismic change that culture will never prevail there.
 
I remember a few years ago during the first of two really cold winters, there was a huge pothole somewhere in North Cork. There was a YouTube clib of a guy swimming in it. It went public and the council filled it in the next day. That's what we need for our A&E departments - an effective public feedback loop. I note that the [broken link removed] site is run by the irishhealth website and it nice & pasteurised - you even have to register & supply an email address to post! A simple YouTube channel where patients on trolleys could upload to, would really shake things up I would imagine. It would be public and global - foreign press could even pick up on it.

With respect to Lean / Sigma, it might work well in some organisations, but in the HSE it would, I believe, just add another layer of fat where more and more staff would be taken away from treating patients to attend a course they will never use.

Regarding the public / private hospitals, I performed consultancy work for a private hospital in the past 3 years. Honestly, you wouldn't believe the stats they gather and use. And I really mean use....everything is analysed and anything outside set ranges is followed up on. Granted, the hospital is private and therefore profit is important but I really think it is time to start privatising some of the functions that the HSE performs, particularly A&E where private hospitals could be paid by the state to treat everything that is currently treated and open 24x7.
 
The majority of those within the system already know what's broken. External feedback won't change that, and external people are usually not aware of the bureaucracy or antiquated systems used internally that contribute to the disfunctional state. Anonymous feedback is worthless in any system.

The public shaming approach didn't work too well for the pothole campaigner from Cavan with the threat of jail hanging over him. Patients on trolleys uploading clips to YouTube could soon find themselves in court also.
 
Firefly said:
With respect to Lean / Sigma, it might work well in some organisations, but in the HSE it would, I believe, just add another layer of fat where more and more staff would be taken away from treating patients to attend a course they will never use.
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6 Sigma is essentially a statistical management tool and that requires considerable training and could suck up resources. Lean and Kaizen are simple and very adaptable tools and don't require much training at all. Once people understand the concept and know that they will be listened to a lot of the low hanging fruit can be picked with little or no cost or disruption.
 
Sosphy. Data is very valuable , my point was that data is very prone to bad -use.(I was being a bit sarky!)

Purple . Agree IF people are listened to = great.
 
Gerry Canning said:
Purple . Agree IF people are listened to = great.
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If people aren't listened to then it's not kaizen. Lean is an output; your process ends up being Lean. If enough processes are Lean then you can say that your organisation will end up being Lean.
 
Great! We're now going to have patients and their friends wielding mobile phones in A+E facilities threatening global fame for all the wrong reasons on Youtube if Padser on the trolley is not treated within 10 seconds. Mobile phones are banned even in GAA dressing rooms in underage occasions. How long will it be before all staff in A+E refuse to work in front of such threats? I haven't even mentioned more patient distress as a result.

Better again, we can bring in some advising company to implement Lean and a plethora of other systems. I am sure Padser's worries will be eased as he continues his horizontal life on the trolley.

And of course, we can continue to ignore those working in such places. We can let morale slide more into the abyss of cynicism.
Doctors will doctor, nurses will nurse, admin will admin, care assistants will care assist and what does Seosamh Ó Galúnach think -only the obvious i.e. teamwork and a decent set of workable ground-rules would matter so much. Let's not dismiss the obvious; if teamwork works, then let it work.
 
mathepac said:
Eddie Molloy and the retiring head of HIQA say it well http://www.independent.ie/opinion/c...s-ever-responsible-for-mistakes-34428484.html

To paraphrase, no-one cares because no-one is accountable.
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Perhaps this should be a new thread, but from the same article, which makes for depressing reading:

“Following last year's HIQA report into infant deaths in Portlaoise hospital, there were calls for sanctions against personnel who had failed "to take seriously" the evidence of repeated catastrophic failures that were brought to their attention.

The best that the CEO of the HSE, Tony O'Brien, could offer when he was pressed about sanctions was to appoint HR consultants from the UK to advise on how these serious failures by several layers of management could be handled.

Here, we have the biggest employer in the country, with over 100,000 staff, which doesn't have an effective performance-management and disciplinary system, one that includes, when required, the legal instruments and industrial relations machinery to impose sanctions on managers guilty of the most egregious lapses. [Emphasis mine]

Questioned before the Public Accounts Committee this week, Mr O'Brien explained how he was powerless to take effective action and, turning the spotlight on his interrogators, he then added wryly: "Because of rules set in this place." [Emphasis mine]

To what rules is he referring?
 
We are all talking like we were at a meeting in which our duty is to solve all the problems in Accident and Emergency (and perhaps in the entire HSE). We are talking management systems, union participation, strong management, bought-in staff etc.

Newsflash Guys! - We are wasting each other's time and all of us would be better off sharing a bar table to watch the Six Nations.

But, the problems especially in Accident & Emergency are about to be resolved in their entirety. (You heard it here first). From where I sit, it appears only a matter of a few short years before our Health System is privatised. And yes, we are getting what we all wish for. (Another round of drinks there, Paddy, the match is about to start!).

So Seosamh Ó Galúnach is jumping all over the place with joy. He will be able to go to A&E receive treatment within minutes and will be cured of all ills. Great! But, Seosamh, bring hard cash or at least a plastic credit card or you can stay outside unseen in the rain if you are not covered by expensive Medical Insurance. And yes, come Monday to Friday, 9.00am - 5.30pm and you will be seen by one of our caring doctors (who works in only three other hospitals and four GP Centres).

Seosamh and his buddies will learn quickly that most ills can now be treated free at any of our Pharmacies. Even if he has private health insurance, the insurance companies will be introducing No Claims Bonus etc. We will have a hospital service rivalling any great hospital in Manhattan. Whether Seosamh likes it or not the government has done a Pontius Pilate job (washed their hands) on the public health facilities and all our hospitals are now private. There will be no delays in Accident & Emergency. We will have a much poorer population. And Seosamh will learn that all he can do now is whistle Dixie. But, Seosamh got what he wished for.
 
Leper said:
We are all talking like we were at a meeting in which our duty is to solve all the problems in Accident and Emergency (and perhaps in the entire HSE).
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I see it as my duty as a citizen to try and ensure that those who need medical care in this country get the best we can supply. The current offering falls far short of that.
Leper said:
Newsflash Guys! - We are wasting each other's time and all of us would be better off sharing a bar table to watch the Six Nations
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Feel free to opt out at any stage and watch telly.
Leper said:
But, the problems especially in Accident & Emergency are about to be resolved in their entirety. (You heard it here first). From where I sit, it appears only a matter of a few short years before our Health System is privatised.
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Yes it will be privatised but that solution was mentioned long ago in this thread by me amongst others. Sorry you missed that from your seat in from of the telly.
 
mathepac said:
I see it as my duty as a citizen to try and ensure that those who need medical care in this country get the best we can supply.
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Now my mind is at ease. Mathepac is taking up the mantle of responsible citizen. All our problems are about to cease. Now back to the telly . . . and Paddy, another pint and a ball of malt there for Mathepac.
 
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