Adding Value to Patient Care in Cork University HospitalMay 23, 2016 -
Author: Tony McNamara, CEO, Cork University Hospital Group
In their editorial in July 2008, the Harvard Business Review laid down a difficult challenge to hospitals worldwide to optimize performance across the full spectrum of services (clinical and non-clinical) that they provide. The editorial stated inter alia:
The most complex workplaces today are tertiary care hospitals. These vast enterprises employ tens of thousands of people who, under one roof, do everything from neurosurgery to laundry.
This is complexity an order of magnitude greater than automobile assembly and anyone who has been hospitalised knows that management has thus far been unequal to the scope of the task.
The workers, managers, consultants and scholars who crack this nut will reshape industries just as profoundly as Drucker, Deming and Onho did.”
These observations, coming from the premier leadership journal for practitioners based in the United States, where expenditure on hospitals dwarfs that in most other countries, is all the more notable because it suggests that high levels of expenditure on health do not guarantee optimum performance.
This challenge coupled with HiQA observations on hygiene, a Ministerial commitment to focusing on standards of nutrition and the desire of hospital staff to maximise the quality of service to patients and staff, provided a powerful motivation for the leadership in Cork University Hospital to implement a challenging change programme in respect of (i) Care Assistant, (ii) Cleaning and (iii) Catering staff that began in 2015 and is currently being implemented. This change process is particularly notable because it is being implemented in a truly partnership way with staff representatives, service managers and hospital leadership all working to support the development of a culture of respect, support, staff development and commitment to quality.
To put this change initiative in context, Cork University Hospital has 4,000 staff of multiple grades of which c. 500 are engaged in these services. It is remarkable for example that our Catering Department prepares and delivers c. 1,000,000 meals each year – a logistical marvel!
The change programme now in process has been a remarkable example of staff from various stakeholder interests working collaboratively and the following change initiatives agreed for implementation provide an indication of the successes to date and the potential to qualitatively add to the quality of patient care in the Hospital;
- New job descriptions have been agreed for all Care Assistants (n. 180) that define requisite levels of training and expertise, reinforced by a commitment from hospital leadership to support on-going professional development to add value to patient care;
- Employment of a Clinical Facilitator to underpin the professional development of the cohort of Care Assistants supporting nursing staff in the carrying out of their roles;
- Separation of Housekeeping and Catering functions to improve sub-specialisation and responsiveness to patient needs;
- Reorganisation of the management of the Housekeeping Management Team to provide for sub-specialisation in the governance of that department;
- Leadership commitment of a development programme for staff in the Housekeeping Department (n.170);
- Consolidation of the standards set out by bodies such as the Health Information and Quality Authority (HiQA) and by other accrediting bodies to provide a clear focus on the standards to be achieved to maximise hospital cleanliness and achieve accreditation for the attainment of cleaning standards in due course;
- Establishment of a mobile specialist team to increase the intensity of cleaning in high-risk areas of the Hospital;
- Consolidation of hygiene and environmental audits to improve the efficiency of the audit process and to improve the quality and value of audits;
- Implementation of a programme of staff development for Catering staff (n. 110) in the context of the provisions of the Department of Health policy on nutrition (2009);
- Revision of menu options to enhance nutrition and increased options for specialist dietary requirements such as renal care, anorexia management and patients with dysphagia;
- Development of shared care processes between dietetic, catering and ward staff.
This is a challenging change programme that has the potential to add significant value to the patient experience in the Hospital. The commitment of staff to embrace this change at a time when there is much (unjustified) criticism of the public service is both admirable and an indication of the commitment of staff to patient care.
The attainment of the holy grail of universal excellence in the delivery of care in our hospitals is a great prize – even if the qualitative measurement of quality remains elusive. The challenge set by the Harvard Business Review of achieving both excellence and symbiosis between the very many clinical and support departments in service delivery is a great motivation.
Perhaps in the pursuit of these objectives we would all benefit from a greater appreciation of the need to pursue excellence in non-clinical as well as in clinical services and appreciate the contribution that ALL staff make to patient care in one way or another.
Comments and feedback welcome. Thank you.