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Irish Health Service Executive: Redesigning hospital services to cut waiting times and treat more patients

In response to pressure on emergency departments and rising waiting lists in Irish hospitals, the Health Service Executive (HSE) established an initiative to improve services by redesigning how clinical care is provided. They asked us to help them put it into practice at a large hospital - to test and prove the approach.

Working together, we focused on patients’ perspective and giving clinical teams the support they needed to make small changes that could bring dramatic improvements. We reorganised the way patients were seen in the emergency department, allowing them to be seen and returned home safely more quickly. Basing a surgeon in the emergency department who could carry out minor procedures without the need to admit patients made a real difference. We helped introduce a system where nurses could discharge a patient based on guidance agreed with the consultant, freeing up much-needed beds.

We had to work carefully with clinicians to turn ideas into practical proposals for how to work differently, unravelling complicated protocols and professional boundaries that had made that difficult in the past.

We successfully demonstrated it was possible to use this approach to have an impact just using existing resources. The pilot has also given the HSE a comprehensive understanding of how to roll out the programme nationally.

But the most important benefit of this work has been a better experience for patients. Average waiting times in the emergency department are down by more than an hour, daily throughput in the acute medical assessment unit has increased by10% and we’ve helped the hospital identify savings of more than €4M a year.

"The small PA team offered an exceptional breadth and depth of expertise, with robust programme management and health service improvement capabilities. They had an ability to work in a highly flexible and pragmatic manner, and when we needed to, we were able to call on additional specialist expertise.
Their collaborative working style meant that we were able to build the capabilities of our own team. Above all, their team were not afraid to challenge assumptions or constrained in their thinking and this refreshing approach was pivotal in securing the commitment of those involved."

Anne-Marie Keown,
Programme Manager,
Special Delivery Unit

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