The EMB is committed to improving the quality of services delivered and developing a culture of safe effective patient care. A number of projects have been identified that reflect national priorities and the need to improve the management of patients who attend the Hospital as emergencies and who are treated as elective patients. The following represents a sample of the many projects that CUH is delivering in support of delivering efficient services in respect of the 500,000 patient interactions that the Hospital has each year.
Hand Hygiene Performance Improvement
Hand Hygiene is recognised internationally as the single most important preventative measure in the transmission of Healthcare Associated Infections (HCAIs). It is essential that a culture of hand hygiene is embedded in every service at all levels. (National Standards for the Prevention and Control of Healthcare Associated Infections; HIQA). HCAIs place a serious disease burden and have a significant economic impact on patients and healthcare systems throughout the world. It is well recognised that good hand hygiene, the simple task of cleaning hands at the right time and in the right way can save lives (WHO 2009).
To maintain a focus on continuous improvement in relation to hand hygiene and cleanliness of the environment a CUH Hygiene Quality Improvement Team was set up in 2014. The team is chaired by the Chief Executive Officer (CEO) and its membership is representative of the multi-professional staff in the Hospital. The team meets on a monthly basis to oversee the implementation of the quality improvement plans at which key staff are accountable for the outcome of audits on topics such as hygiene and the environment.
The key priorities for the Team can be classified into four main areas:
- Revised governance and reporting systems
- Hand hygiene performance improvement
- Cleaning practices and cleanliness of patient equipment
- Management of the physical environment
- Education
The Hospital has developed a quality improvement plan to include an audit mechanism and review of all hand hygiene facilities and a plan for replacement of equipment where required. The details are outlined in the CUH Policy and Procedure on the Management of Hand Hygiene Audits.
The plan incorporates a requirement for the Clinical Nurse Manager/Clinical Nurse Midwife of every ward, under the leadership of the Director of Nursing/Director of Midwifery to develop plans to improve hand hygiene and cleanliness and to provide monthly progress reports against the plan to the CEO led Hygiene Quality Improvement Team.
Role Of The Health Care Assistant
The role of the Health Care Assistant is evolving and is acknowledged as a critically important part of the multidisciplinary team delivering patient care. As part of the work of the Hygiene Quality Improvement Group, a review of the Job Description was undertaken to identify areas of improvement and in particular the opportunities to support Care Assistants in respect of their continuous education and professional development needs.
Scheduled Care Programme
In 2013 a CUH Scheduled Care Governance Group was established chaired by the CEO to oversee the implementation of the HSE policy on the management of inpatient and daycase elective care. The Group leads the implementation of processes that are standardized on a national basis and which set standard for the management of waiting lists for scheduled care.
The Groups’ critical function is to ensure appropriate governance is exercised in the management of inpatient / day case waiting lists and to ensure that there is complete, accurate, validated patient information for waiting lists. Critical to the achievement of waiting list targets is assurance that key functions such as theatre, out-patient facilities and diagnostic services are delivered optimally and these critical support departments have undergone enormous change in the past three years with more changes planned for 2016 based on lean management techniques.
A number of key change initiatives have been implemented which have resulted in an improvement in the delivery of scheduled care including:
1. Compliance with national policy on the management of waiting lists;
2. Implementation of measures to achieve waiting list targets in a sustainable way;
3. Implementation of recommendations contained in the Surgical Care Programme to improve patient experience;
4. Supporting the Surgical Directorate and the Theatre Users Group to improve efficiency in the management of patients through theatre, recovery and the ward;
5. Implementation of a Surgical Assessment Unit to support the Emergency Department;
6. Implementation of Day of Surgery Assessment Unit and Pre-Admission Assessment Unit;
7. Implementation of a theatre management IT system to improve efficiency in theatre and to support Activity Based Funding;
8. Reorganisation of the Bed Management Department to ensure that all admissions are managed through a centralised booking system;
9. Implementation of an Electronic Booking System.
The key enablers to support the full programme are outlined in Appendix 4 and in the CUH Scheduled Care Patient Pathway Booklet.
In 2013 the CUH Unscheduled Care Governance Group was established to oversee the delivery of emergency care. This Group incorporated the Acute Medical Care and Emergency Care Programmes to maximise the potential synergies in both. This enabled a structured work stream to be developed to effect improvements in the management of emergency care and to improve the patient experience. These strategies and change initiatives are documented in the CUH Unscheduled Care Patient Pathway Booklet 2014.
The Executive Management Board, cognisant of the need to further develop improvement strategies for emergency care continues to implement initiatives that will improve the patient pathway and enhance the patient experience. In 2015 a number of these changes were encompassed in two major initiatives (i) Patient Flow Ten Point Action Plan and (ii) Patient Flow Action Cards.
In order to address the multiple challenges in emergency care, strong leadership is required both in hospitals and in the community and the delivery of efficient smooth emergency care lies in the implementation of multiple changes initiatives involving the hospital, community and ambulance services which will be a focus for 2016.
Lean Six Sigma - Value Stream Mapping Projects
A value stream map is a visual depiction of a process or workflow which originated in the lean manufacturing industry. It is a series of techniques and measurement processes that helps organisations identify and minimise waste in its process and is becoming increasingly important in improving healthcare delivery.
The EMB is committed to implementing Lean and Six Sigma principles to improve the efficiency of services and to minimise redundancies in the process of delivering care. In 2014 these principles were applied in a week-long study of patients attending the Emergency Department to ascertain the potential to improve the patient pathway and to reduce time spent in the Department and this work has been extremely important in improving patient care for patients presenting as emergencies.
The EMB will continue to support the use of lean mapping techniques to identify improvements in the patient flow areas and a number of staff have completed projects from which the learning has been applied within the Hospital such as:
• Predicted Date of Discharge – a lean management initiative to improve the identification of the Predicted Date of discharges (PDD) for patients to improve patient flow processes;
• Reduction in Theatre Collection Times – a lean management project that has reduced the time taken to transfer patients from theatre to wards resulting in improved patient flow and better use of resources.