A new university course aims to tackle the health service crisis by applying process techniques to reduce A&E waiting times and discharge delays. Éibhir Mulqueenreports
A new University of Limerick course is aimed at tackling part of the crisis in the health services by teaching techniques of process management to hospital managers.
The Diploma in Quality Management Lean Healthcare Systems, an online, distance learning course, will apply process techniques originally used in the car manufacturing industry, most famously in the Toyota Production System which focused on eliminating large amounts of inventory and other "wastage" in the production process.
Eamonn Murphy, professor of quality and applied statistics and director of UL's Enterprise Research Centre, says the Lean system could be used to reduce waiting times in A&E or discharge times and thereby increase the overall efficiency of hospitals.
"We see ourselves in the forefront of new ideas and bringing new ideas and new research into Irish productivity," he says.
A recipient of an excellence in research award from UL in 1999, he has been a consultant on more than 60 manufacturing design projects in 40 companies in Ireland, Britain and Hungary. He believes it is only now that the health service is ready to take on these ideas. "This is a perfect time to introduce this to the health service. Up to now money was not the issue. They were not closing hospitals or wards until this year. They realised we could not do this the same way."
Every hospital chief executive has to buy into it along with the middle managers, the "key players", he says, for it to work.
He points out that process management ideas are not new for healthcare systems but were introduced in an early form in the US in the 1930s.
"Even at that point in the US they were very clear: there is the clinical path, which is defined and handled and managed by health professionals. We are not in that space at all.
"There is a parallel world called the patient trajectory. That is what we are talking about.
"There is a process to admit people and there is a process to discharge people and the process is independent of people providing the service."
The 33-week-long Lean Healthcare Diploma will start in February and costs €4,000. It is aimed at training hospital managers to implement processes to reduce waiting lists, inventories and paperwork, increase the efficiency of patient transfer and prevent errors occurring in hospital product labelling.
Prof Murphy says the course is not a panacea for all the inefficiencies of Irish hospitals "but it certainly will help considerably". "International experience, which we have looked at closely, has shown that very significant improvements are achieved by healthcare management teams who have engaged in Lean courses."
Some "simple" examples of successes following the adoption of Lean methodologies, he says, include a 33 per cent reduction in the number of patients in the waiting area of a Barcelona hospital clinic; a 60 per cent decrease in searches for missing medication at the LDS Hospital, Salt Lake City; and a 40 per cent decrease in missing medication notifications over a one-month period at the Community Medical Centre, Missoula, in the US.
"The NHS in Britain has invested a fortune in this whole concept and they have an academy and a centre for innovation and process improvement in Coventry.
"The ISQSH [Irish Society for Quality and Safety in Healthcare] became aware of what was happening in Britain. They came to us and said they thought it was very relevant for the Irish health system."
He cites an Irish example, from Tallaght hospital, a partner, along with the ISQSH in the development of the course, saying that €1 million has been saved there following the adoption of new management processes. Three managers from Tallaght signed up for his centre's Diploma in Quality Management.
"You need the individuals to have the skills and competence but then you also need the organisation to implement the ideas. Tallaght set up and has in place a model.
"We have brought three of the Tallaght people through our programme. They will graduate with the industrial qualification rather than the health qualification."
The other partner in the course is the Bon Secours Health System.
Having had a lot of engagement with multinational companies, starting with Digital and continuing through to companies such as Dell, Intel and Boston Scientific, he believes management processes in Irish hospitals are at a different level to industry in general. "It is not an easy mix, these cultures.
"In industry, standards are aggressive, and that mentality does not exist in the healthcare environment. I think it should. "It is not a question of money. We have thrown more money at this thing than you can humanly think," he says.
Even within the healthcare systems, standards vary enormously. He has statistics from hospitals in Cork, Limerick, Galway and Waterford showing widely diverse rates of waiting times in A&E.
"The waiting times in Waterford are very low and they appear to have much fewer nurses in their A&E than other hospitals. It is not about nurses or resources, it is about processes and procedures.
"At the end of the day we would have put people through our process ranging from Dublin Bus to Eircom to the Irish Army.
"The problems are essentially the same."