The curious case of models 2 & 3

1. The Curious Case of…
Model 3&2
(adapted from Curious Case of Benjamin Button)
Avilene Casey
SDU Liaison Officer
Hon President of IADNAM

2. Background -Hospital Models
O Government redesign of acute hospital system –
Future Health 2012 – 2015, Small Hospital Framework 2013,
Establishment of Hospital Groups 2013
O Health Service Reform programme – move from
hospital centric model of care
O Clinical Care Programmes AMP, NSP etc.
O National Standards for Safer Better Healthcare –
towards Licencing
O HIQA reports
O EU Directive

3. Rationale for Establishment of
Hospital Groups
O Large range acute hospitals operating in relative
isolation
O Duplication and fragmentation of resources
O Difficulty in recruitment and retention of key clinical
staff
O Non compliance with EU Directives
O Inequitable distribution of workload and resources.
(Adapted from Professor John R. Higgins May 2013)

4. Objectives
O Improve the quality of patient care
O Improve access to appropriate services
O Improve cost effectiveness
O Improved health outcomes and satisfaction for
patients
Need to create a paradigm shift in the way acute
care is managed.
Right staff, Right Skills in the Right Place

5. The Importance of being a
Model 3 or 2
“Now produce your explanation and pray make it
improbable.”
― Oscar Wilde, The Importance of Being Earnest

6. Model ‘s
O 9 Model 2
O 26 Model 3
O 8 Model 4
(reference DoH, AMP, NSP and SDU)

7. ED Attendances and Admissions
YTD All Hospitals ED
Attendances
166,414
YTD All Hospitals ED
Admissions
45,252
Model 4 ED Attendances 70, 557
Model 2&3 ED
Attendances
95, 587
Model 4 ED Admissions 19,005
(26.9%)
Model 2&3 ED
Admissions
26,247
(27.4%)

8. Importance of Model 3-2
O Improve patient flow across the continuum of
care
O They will act as the hub in an integrated
system of primary and hospital care
O Deliver faster access increasing volume of
elective services in selected specialities
O Treat patients at lowest level of complexity
safely, timely, efficient and as close to home
as possible

9. Emerging Focus
- Leading care across the Continuum
O Preventing avoidable
patient
admissions/readmission
s
O Equipping Patients for
long term self
management
O Building readmission
prevention strategy
O Improving discharge
instruction
O Enabling safe
transition home or to
other sites
O Creating bi-directional
patient flow streams

10. Role of Model 2 Hospitals
O Change in health trend showing an increasing
use of day case procedures in all specialities
O Enable GP and Primary Care teams to
support patients in their own community
O Rehabilitation is a major role of small
hospitals
O Health promotion- prevention and
management
O Care for differentiated low risk
medical/surgical patients
O Elevating the patient & family experience

11. Service Opportunities
O Day Surgery – & 2S – fit but need stay
O Ambulatory Care – Chronic Disease management,
assessment of older persons
O Medical Services – Clinics e.g. cardiac failure, Rehab,
COPD
O Diagnostics Bloods X-Ray endoscopy, bronchoscopy
etc.
O Palliative Care
O Patient centred care – decision making, needs,
experience

12. Service opportunities continued
O Collaborative working
O Development of common standards of care
O Flexible movement of clinical staff
O Robust patient transfer arrangements based on
clinical need
O Ambulance bypass, transfer & repatriation
protocols
O Entire group expertise and resource realised
O Building a competent engaged workforce

13. Nursing opportunities
O Working across sites/boundaries -Nursing can
become the integration
O Nurse led OPD clinics – pre surgery
assessment
O Advanced roles - Reframe redesign
O Specialist roles
O Engaging the nursing workforce
O Preparing graduates for service

14. Challenges
O Politics – Professional, government
O Culture
O Emotion – societal role
O Education
O Physical/Technical
O Structure
“You can be as mad as a mad dog at the way things went. You
could swear, curse the fates, but when it comes to the end,
you have to let go.” – Benjamin Button

15. Challenges continued
O How do you use the experience wisdom and talent
that currently exist in your service in a different
way ?
O Development of Competency Frameworks to meet
the new service delivery
O Robust assessment skills,
O Patient flow requiring a high level of efficiency and
coordination, data interpretation
O Discharging – nurse led
O Leadership accountability for performance

16. Intervention Area Metric National
target
2010 2013 Trend
1
Assess and avoid admission
% of patients with LOS=0 25% 11.54% 23%
2
Short Stay Unit
% of patients with LOS 1-2
days
31% 25.36% 24%
3
Efficient Processing of ordinary
patients
% of patients with LOS > 2
days
44% 63.10% 53%
4
Complex discharges.
% of patients with LOS >14
days
11% 13.12% 10.8%
Area 4 % BDU of patients with LOS >
30
33% 34.82%
Areas 3 and 4 AvLOS for those staying >
2days
6 -10
days
12.87 12.4
Overall AvLOS for medical
patient
5.8 days 8.48 6.94
Acute Medicine KPI Results
Data Source: HIPE, ESRI
© Acute Medicine Programme HSE Ireland

17. Medical AvLOS for 2009, 2010, 2011, 2012, 2013
7
7.2
7.4
7.6
7.8
8
8.2
8.4
8.6
8.8
9
Jan
10
Jan
11
Jan
12
Jan-
13
Time Period
AvLOS(days)
Data Source: HIPE, ESRI
© Acute Medicine Programme HSE Ireland

18. What now
O Exploration and agreement
 Locally – front line staff with service intelligence
 Regionally DON’s within Group/network of Model
2 & 3 DON’s
 Hospital Group Governance Structures
 IADNAM
 Clinical colleagues - Colleges
 National – ONMSD, DoH, 3rd level Institutes, NMBI
 Create a unified national vision and strategy

19. For what it's worth: it's never too late or, in my case, too early to
be whoever you want to be.
There's no time limit, stop whenever you want. You can change
or stay the same, there are no rules to this thing. We can make
the best or the worst of it. I hope you make the best of it.
Benjamin Button looking back on his life says:
Thank you.