Health Sevice Excellence Awards - April 2016 by BeCreative

Health Service Excellence Awards Building a Better Health Service

Meet the finalists: West Ophthalmology Service π Acute Coronary Syndrome Programme π Community Epilepsy Outreach Service Family Summer Wheelchair Camps π Little Things Mental Health Campaign Community Virtual Ward π Temple Street Children’s University Hospital

Health Service Excellence Awards Criteria Seven projects have been selected to compete to be the Overall Winner of the 2016 Health Service Excellence Awards. Shortlisting took place in January 2016 and teams from the shortlisted projects were then invited to present to the Selection Panel to qualify for the Health Service Excellence Awards Final 2016. The Overall Winner will be selected tonight (April 27th) in Farmleigh House, Phoenix Park, Dublin. The final seven projects have been selected from an original entry of 426 projects. They were chosen by the Selection Panel after 39 projects were invited to make presentations detailing their aims and objectives. The criteria for the Heath Service Excellence Awards were as follows: HSE VALUES: the extent to which HSE values – Care, Compassion, Trust and Learning – were demonstrated and evident. INTEGRATION: assessed the extent to which projects supported healthcare workers, regardless of whether they were hospital or community based, to work together in teams, planning and delivering care seamlessly. The project needed to show evidence of enabling and encouraging this integrated way of working. EXPERIENCE: assessed the evidence that the project addressed and impacted on quality of service, patient/service user safety, and care. It also assessed compliance with Health and Safety Legislation. Projects were asked to clearly identify improvements achieved in patient experience, quality of care and patient safety. ENGAGEMENT: assessed the degree to which projects created channels that ensured involvement or consultation with all relevant stakeholders, including patient/service users staff, unions and partnership processes. The method and types of tools used to communicate with both external and internal customers were assessed throughout the duration of projects. TRANSFERABILITY: assessed the potential for learning from projects to be replicated to other parts of the health services. This could include the overall approach, specific features or specific outcomes of the project. EFFICIENCY AND VALUE FOR MONEY: assessed how the project created a more streamlined approach to service delivery and delivered increased efficiencies/resource savings. DIVERSITY, EQUALITY AND INCLUSION: the HSE is committed to creating a setting wherein all employees, regardless of race, religion, ethnicity, gender, sexual orientation, responsibilities for dependents, age, physical or mental disability, membership of the Traveller community, or geographic location, are respected, valued and can reach their full potential. The aim is to develop a workforce in the HSE which reflects the diversity of Irish society, and which is strengthened through accommodating and valuing different perspectives. Projects which reflected practical initiatives in supporting the HSE’s Diversity, Equality and Inclusion statement were welcomed and were asked to demonstrate components of this statement. MEASUREMENT AND RESULTS: assessed how projects measured change/innovation within their service as a result of the project. UNIQUE FEATURES: applicants were asked to highlight unique features of their project that could fall outside the other criteria. Read about the final seven projects from page 4. Turn to page 14 for a full listing of the shortlisted 39 projects

HEALTH SERVICE EXCELLENCE AWARDS SELECTION PANEL Mary Kemple, School of Nursing, Health Sciences Centre, UCD Geraldine Smith, HSE Assistant National Director, Internal Audit Chris Rudland, Complaints Governance & Learning, Quality Assurance & Verification Division, HSE Dr Philip Crowley, National Director, Quality Improvement Division, HSE Hilary Dolan, National Co-ordinator, Health Service Excellence Awards Joan Gallagher, Policy Analyst, Office of the HSE Director General Maureen Browne, Journalist, Editor of Health Manager Dr Jerome Coffey, National Director, National Cancer Control Programme Leo Kearns, CEO, Royal College of Physicians of Ireland

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12 CONTENTS 04 A CARING HOME

Clare Lewis, Clinical Case Manager of Ireland’s first Community Virtual Ward for Older Persons, explains how the new model can help to change the way people are managed within the primary care setting

05 IT’S THE LITTLE THINGS

Little Things, a positive mental health campaign created by the HSE’s Mental Health and Communications Divisions and 32 partner organisations, aims to promote positive mental health and reduce the loss of life through suicide

06 WHEELCHAIR-FRIENDLY FAMILY FUN

Wanjiru Waweru-Kihara, Clinical Specialist in Paediatric Occupational Therapy, explains how Family Summer Wheelchair Camps, Co Louth, has helped to encourage children to enjoy life and feel more independent in their wheelchair use

07 ‘RIGHT PEOPLE, RIGHT SKILLS, RIGHT PLACE, RIGHT TIME’

The Ophthalmology Service in Sligo University Hospital has joined forces with colleagues working in the community to create an improved model of care for patients

08 & 09 IMPROVING TREATMENT FOR HEART ATTACKS

10 & 11 CHANGED FOR GOOD

Dr Rob Cunney and Michelle Kirrane spearheaded an initiative at Temple Street Children’s University Hospital to raise compliance with antibiotic prescribing guidelines for children admitted via the Emergency Department

12 BRINGING THE SERVICE TO THE SERVICE USER

When Dr Daniel Costello, Consultant Neurologist/Epileptologist at Cork University Hospital, realised that his patients with intellectual disabilities – who were also experiencing epilepsy – couldn’t come to him, he decided to go to them

13 WORKING TOGETHER TO MAKE IMPROVEMENTS THAT MATTER

Joe Ryan, HSE, on supporting people building a better health service; and Dr Áine Carroll, National Clinical & Integrated Care Programmes, on recognising the innovation of the finalists

14 & 15 SHORTLISTED PROJECTS, 2016 HEALTH SERVICE EXCELLENCE AWARDS

The shortlisted projects which have all made a lasting impression on our health and social services

The Acute Coronary Syndrome Programme is ensuring patients suffering from a STEMI (major) heart attack have direct access to standardised, high-quality services in designated centres around Ireland

Irish Independent | 27 April 2016

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INTRODUCTION

cross the health system a talented, committed workforce through its collective knowledge, skills and hard work provide excellent health services to those who need care and to the wider community. It is very important that we provide opportunities to recognise and celebrate the commitment and outstanding contribution of health and social care staff. This is why today we are honouring the best projects to come through the 2016 Health Service Excellence Awards at a special presentation ceremony in Farmleigh. The awards were created to highlight the projects or services that have made a real and lasting improvement to our health and social services. A number of months ago, we asked our staff to tell us about interesting projects which they and their team colleagues have been involved in, in order to improve health services for those who need them. This awards ceremony recognises all of these great projects and provides an opportunity for staff to showcase their successes. In the context of the massive improvement project that is well underway in the health services currently, the awards ceremony is intended to encourage and inspire all staff members to get involved in developing better services that result in easier access and high-quality care for patients. The awards ceremony is also intended to promote pride among staff in relation to the services that they deliver. The competition was open to all staff working in the public health system, directly run or funded by the HSE. This included any service provided directly to the public, including clinical services, primary care or social/family support; support services including catering, portering, security, clerical and management to include people management processes, information technology or service-management initiatives.

One of the areas of action in our People Strategy 2015â&#x20AC;&#x201C;2018 Leaders in People Services is staff engagement and this competition is part of our ambition for staff to have a strong sense of connection to our service, take personal responsibility for achieving better outcomes and support their team colleagues to deliver results. We hope that via todayâ&#x20AC;&#x2122;s event, and subsequent showcase events to be held during the summer, we will be able to ensure that the learnings from excellent projects around the country can be transferred and replicated where appropriate. We hope that you enjoy reading this supplement and finding out about the excellent work being carried out in the health services by our finalists and shortlisted projects.

Tony Oâ&#x20AC;&#x2122;Brien Director General, HSE

and

Rosarii Mannion National Director of Human Resources HSE

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Editor: Clodagh Dooley Subeditor: Ben Murnane Advertising: Terri Byrne | 01 705 5469 Design: Susan McClean, INM Design Studio, Belfast Repro: Independent Newspapers (Ireland) Limited, 27-32 Talbot Street, Dublin 1

27 April 2016 | Irish Independent

Health Service Excellence Awards | 3

A Community Virtual Ward to support older persons within the community with complex health and social care needs by HSE Primary Care Services, Dublin North

A caring home

Clare Lewis, Clinical Case Manager of Ireland’s first Community Virtual Ward for Older Persons, explains how the new model can help to change the way people are supported within the primary care setting

SE Primary Care Services in North Dublin worked with the gerontology services in Beaumont Hospital; Nursing and Midwifery Planning Development Unit Dublin North (NMPDU); and Royal College of Surgeons Ireland Nursing & Midwifery (RCSI), to create the country’s first Community Virtual Ward for older people. “The Community Virtual Ward has up to 50 patients who have complex health and social care needs,” says Clare Lewis, Clinical Case Manager. “The patients live at home and the project is overseen by myself and my colleagues to ensure that they receive the services they require during critical periods of illness and/or functional decline. “With an increasing aging population, this new model was developed to support older people in order for them to remain at home for longer, to ease the burden on overstretched hospital services and to reduce the number of unplanned hospital admissions. We aim to provide care of the highest quality within existing sources that meets the patient’s needs during a critical event.” INTEGRATED CARE Clare is supported by a multidisciplinary team, including specialists in gerontology and chronic disease management, palliative care and hospital bed management; the Emergency Department including the Frailty Intervention Team; the Community Intervention Team who support out of hours for those on the cusp of a hospital admission; the primary care team, including the patient’s GP, community nurses, services for older persons, and allied healthcare professionals. Each plays a part in assisting the clients to stay at home longer and avoid hospital admission. The initiative has assisted in improving the quality of life for clients and their carers, including family members, and integrated primary and secondary care services in a patient-centred model with the Day Hospital for Older Persons Care at St Joseph’s in Raheny, Dublin as a central hub. Clare explains that the clinical case management service receives referrals from the day hospital, outpatient and inpatient gerontology services, and clients are assessed, triaged, and admitted to the virtual ward. This operates on a traffic light system of red (high risk), amber (moderate risk) and green (low risk). “If patients are in the red virtual ward, then the level of assessment and types of services and monitoring are much higher. If they do require a hospital admission, then the aim is to plan this to bypass the Emergency Department and admit direct to the specialist gerontology ward. When risk is reduced, the patient is then moved into the amber ward and monitored for approximately two to four weeks. Clients are considered nearing discharge from the service once admitted to the low-risk (green) category, for continued follow-up by the primary care team.” Clare says there have been very good outcomes in supporting people at home. “The number of Emergency Department admissions within a high-risk group and within system resources have been reduced by 87 per cent, with a reduction in bed day use by 81 per cent. This initiative is being developed by the NMPDU in conjunction with the RCSI through a clinical academic approach – this has been critical to the introduction of the change in the way care is developed, implemented and evaluated to improve quality outcomes for patients, including the integration of the Community Virtual Ward electronically aligning with the eHealth strategy Ireland.”

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LOOKING AHEAD When the project was shortlisted as one of the final seven in the Health Service Excellence Awards, Clare was delighted. “I’m thrilled because this project required no additional resources- it was just about working creatively within the existing resources, and looking for models that could work,” she says. “It’s about prioritising service intervention, monitoring and supporting older people to remain at home. It’s wonderful to see that it is starting to get recognition because it is very novel and new, and people may not always understand until they actually see the outcomes and the improvements. “To be recognised at that level has been wonderful for us. There has been a lot of work and research involved to provide a model that works within the existing HSE system and also suits the wishes and needs of the older people themselves and their families. “It would be wonderful to get additional leadership to roll this project out – it’s a model that can be used in other care areas also, such as palliative care, for those with mental health difficulties or disabilities. This is a model that could really help to change and evolve how we manage people within primary care, and give families the opportunity to have contact with the relevant professionals at the right time during that critical period.”

Pictured L-R: Maureen Morris and her daughter, Carol Morris. Photo credit: Angela Halpin

Pictured L- R: Dr Alan Martin, Consultant Geriatrician Beaumont Hospital; Dr Linda Nugent, Lecturer and Programme Director Royal College Surgeons Nursing and Midwifery; Louise O’Regan, Senior Occupational Therapist; Mary Walshe, Area Manager HSE CHO 9; Clare Lewis, Clinical Case Manager Older Persons; Eithne Cusack, Area Director Nursing and Midwifery Planning and Development Unit; Joan Naughton, Clinical Nurse Manager St Joseph’s Day Hospital & Ivan Clancy, Senior Physiotherapist. Photo credit: Angela Halpin

INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE – BUILDING A BETTER HEALTH SERVICE The over-65 population is growing by approximately 20,000 each year, while the over-85 population (which typically has the greatest need for health services) is growing by some 4 per cent annually. Older people with care and support need a range of services such as home care, day care and intermediate

residential care to avoid unnecessary acute hospital admissions and have their treatments and supports delivered within their local community at primary care level in so far as possible. Work has commenced on the steps required to progress the Integrated Care Agenda for Older Persons, including

the initiation and design phase involving consultation with service users and carers (including representative groups) as well as service providers. Visit www.hse.ie and use the Search Box to find Integrated Care Programme for Older People

Irish Independent | 27 April 2016

Little Things Mental Health Campaign

At the Offaly Little Things Photography Competition Awards were (l-r) Eamonn Dooley, Cathaoirleach, Offaly County Council; Patrick Rundle, second place; winner Sarah James; third-placed Theresa Cole; GAA analyst Michael Duignan; and HSE Regional Resource Officer for Suicide Prevention Josephine Rigney

Gary Seery, Robert Carley and Alan O’Mara

It’s the

Little Things Little Things is a positive mental health campaign, created by the HSE Mental Health Division’s National Office for Suicide Prevention, the HSE Communications Division and 32 partner organisations, which aims to promote positive mental health

“A

ccording to World Health Organisation, approximately one in four people will experience a mental health difficulty,” says Gerry Raleigh, Director, HSE’s National Office for Suicide Prevention. “However, every single one of us will experience dips in our mental health, it is part of being human. “We created this campaign to answer two key questions that we all need the answers to in order to be able to look after our mental health and support those we care about, ‘What can I do?’

and ‘Where can I go?’. The Little Things campaign is designed to change the shape and tone of the mental health and suicide prevention sector by encouraging everyone to work together and solve a major signposting issue for the public.” Kahlil Coyle, Little Things Campaign Manager, explains: “The #littlethings campaign highlights that we all experience difficult times in our lives, and that when we do, there are evidence-based things that can make a big difference to how we feel. These include talking about our problems, connecting with others, drinking less alcohol,

CONNECTING FOR LIFE – BUILDING A BETTER HEALTH SERVICE Ireland’s suicide prevention strategy Connecting for Life 2015-2020 aims to reduce suicide in the whole population and amongst specified priority groups; reducing the rate of presentations of self-harm in the whole population and amongst specified priority groups. The role of the HSE National Office for Suicide Prevention (NOSP) is to effectively support, inform, monitor and co-ordinate the implementation of Connecting for Life.

The Connecting for Life strategy is to be realised through seven goals: 1. Better understanding of suicidal behaviour 2. Supporting communities to prevent and respond to suicide behaviour 3. Targeted approaches for those vulnerable to suicide 4. Improved access, consistency and integration of services 5. Safe and high-quality services 6. Better data and research For more information, visit www.hse.ie and use the Search Box to find Connecting for Life

27 April 2016 | Irish Independent

Liam Silke, Keith Walsh (Manager), Adrian Varley, and captain Paul Conroy

sleeping and eating well and exercising regularly – the key is doing these with the intention of it being good for our mental health. These little things can help us to cope with life’s ups and downs, but there are also supports and services. You can find information online at yourmentalhealth.ie, or contact the Samaritans’ 116123 free-to-call number for a listening ear. The Little Things campaign features the lived experience of four generous people, Robert, Alan, Una and Gary, who have shared their experience of life’s storms and what worked for them in getting through tough times. Their stories have been animated and recorded into TV and radio adverts and have been widely shared nationwide. A HELPING HAND Since the start of the campaign, the response has been very positive. yourmentalhealth.ie has received more than 280,000 visitors; there has been a 20 per cent increase in calls to the Samaritans and almost 40 per cent of respondents said they did something with the intention of looking after their mental health. “Part of the success of Little Things is thanks to the involvement of our partner organisations, such as the GAA, Samaritans, Suicide or Survive, Mental Health Ireland, the ISPCC, SpunOut.ie and Alcohol Action Ireland, who have spread the campaign’s message,” says Kahlil. “There are also so many examples of HSE staff members who have embraced the campaign and not only made it part of their work but have gone above and beyond to develop amazing local partner-

ships. For example, Ciarán Lynch, a Clinical Nurse Manager in Galway, has done some brilliant work. He led out a major event for physical health in June that was linked to Little Things and the GAA, building a very strong local partnership with the GAA. Many of the HSE’s Resource Officers for Suicide Prevention have incorporated Little Things initiatives in their local work, particularly around World Suicide Prevention Day and World Mental Health Day.” Kirsten Connolly, the HSE Deputy Director of Communications, describes the impact of the campaign for the public. “Our research clearly showed that knowing where to turn and what to do when experiencing a mental health dip for yourself or a loved one could be confusing and was unclear for many people. There was much good work going on in the sector in relation to raising awareness of mental health but challenges remained with regards to signposting and accessing services. “We sought to make the pathway to information, services and support clear with yourmentalhealth.ie and the single contact number provided by the Samaritans. Thanks to the support of the many partner organisations, the experience for the public around accessing clear and trusted information on mental health is now easier for those who need it. We are very grateful for all the support and collective working that got us here and it’s great to see that recognised in the nomination for a Health Service Excellence Award.” For more information on the Little Things Campaign, visit www.yourmentalhealth.ie

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Family Summer Wheelchair Camps by Paediatric Occupational Therapists, Co Louth

Aidan McKevitt playing with his two sons Aaron and Nathan. Photo credit: Barry Hunt

Wanjiru, Occupational Therapist, making a smoothie with Beni Shamavu and Aaron Morgan. Photo credit: Barry Hunt

Wheelchair-friendly family fun In 2014 Wanjiru Waweru-Kihara, Clinical Specialist in Paediatric Occupational Therapy for Louth Disability Services, felt there was a need for summer camps that were accessible to children in wheelchairs. Here, she explains how Family Summer Wheelchair Camps, Co Louth, has helped to encourage children to enjoy life, have fun and feel more independent in their wheelchair use

“I

n our local community, there are many organisations that offer children summer camps, but most of them are not suitable or the facilities are not accessible for children in wheelchairs,” explains Wanjiru. “Child wheelchair-users receive an occupational therapy service but this can be dreary, especially if provided in the same format and facility. “Two colleagues, Cathriona Reilly, Siobhan McGee and I sought to find creative ways to revitalise the service by injecting a fun-filled way of meeting clinical goals and adopting a familycentred approach, a primary vision of the HSE Progressing Disability Services for Children and Young People Programme. We wanted the camp to give these children ownership, where they feel it’s their camp, and also include their families, boost their self-esteem and provide a teambuilding experience.” SUPPORT After conducting a survey around the area and realising that parents of wheelchair users were on board with the idea, Wanjiru, Cathriona and Siobhan approached the local church (Drogheda Presbyterian Church), who kindly allowed them to use their facilities, providing access to a spacious hall, changing room, toilet and kitchen. The Family Summer Wheelchair Camp is held for four full days for independent wheelchair users (manual and powered) aged 4-18 years old and their families, and the daily attendance ranges from 35-45 participants. Activities include wheelchair basketball, wheelchair dancing, javelin, wheelchair races and many more. The camp team has now expanded to include other members of the MDT (multidisciplinary team), such as a physiotherapist, social workers and mobility service managers. Go Kids Go!, a UK-based charity organisation, also comes to help teach children wheelchair skills, while adult wheelchair users, Nicola McDonell, Patrick McNeary and Owen Mullen, regularly visit to share their own experiences with the children, to motivate and inspire them. Wanjiru says: “Our main goals are to teach wheelchair activities that lead to a healthy lifestyle and physical fitness; teach daily living skills such as cooking and shopping; develop and enhance wheelchair-use skills such as wheelchair control; and allow children to have fun and enjoy

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Camp participants arriving at the camp venue, Drogheda Presbyterian church. Photo credit: Barry Hunt

being part of activities in the community. “It is so important that the child’s parents and siblings partake in the wheelchair activities, as this gives them an understanding of their child

and a better appreciation of the frustrations and the challenges the wheelchair users may feel. It’s a level playing field – everyone’s playing the same game from the same perspective.”

JOY AND LAUGHTER Wanjiru says since beginning the project, the team have observed increased activity participation, mastering of independence skills, increased self-esteem, improved use of wheelchairs and, not to mention, an increased interest in wheelchair sports in the area - with the help of the Irish Wheelchair Association, the parents have organised various wheelchair-based activities. “The opportunity to make a child in a wheelchair simply feel and be a child, by participation in childhood occupations, is overwhelmingly good. To be able to create an environment in which a child is intrinsically motivated to learn even the most challenging skills gives me the greatest job satisfaction. One father told me his family have never been able to go on a holiday together and the camp made it feel like one. Another father said he always envied other dads who play with their children and now treasures the first time he has ever been able to play with his child – this feedback gives me joy. “To be shortlisted to the final seven projects in the Health Service Excellence Awards is surreal and a big achievement in itself. I feel like we have already won because we are able to showcase what we do and hopefully people in other regions who don’t have these kinds of facilities will be spurred onto replicate our idea on a national level – that would be the greatest achievement of all.”

TRANSFORMING LIVES – BUILDING A BETTER HEALTH SERVICE The HSE’s ‘Transforming Lives’ programme sees the implementation of a fundamental reform of Disability Services in Ireland. This reform programme is about putting people with disabilities at the centre of service delivery and includes significant change right across a range of HSE services, including: π Children and Young People’s Disability Services – the reform of these services aims to ensure all children and young people have one clear referral pathway irrespective of their disability, where they live or what school they attend. Organising services and professional staff into geographically-based Children’s Disability Network Teams aims to

ensure consistent and equitable access for all those who require support. π Reconfiguring day services for adults with a disability to ensure people have the widest choice possible about how to spend their time. Services are moving away from general group-based activities to more individualised activities that are based in the community and tailored specifically for the person and their particular interests and likes. π Moving away from an institutional model of service to one where people with a disability live in the community with choices about where they live, who they live with and how they spend their time. This model of

community living is being implemented nationwide in consultation with residents and their families. π The Transforming Lives Programme is committed to continuous improvement in HSE services, engaging and involving service users, their families and advocates, and working in partnership with disability service providers and representative organisations to ensure that people with disabilities are empowered to live ordinary lives within their own communities. Visit www.hse.ie and use the Search Box to find Transforming Lives

Irish Independent | 27 April 2016

Sligo University Hospital / Sligo Leitrim West Cavan CHO Ophthalmology Service

‘Right People, Right Skills, Right Place, Right Time’ The Ophthalmology Service in Sligo University Hospital has joined forces with colleagues working in the community to create an improved model of care for patients

“U

nless we started thinking outside the box, we were going to be left with a large waiting list!” says Paul Mullaney, Consultant Ophthalmology Surgeon, Sligo University Hospital. “We had a nearly two-year outpatient waiting list for general ophthalmology, with 1,500 new patients waiting to be seen.” A BETTER DIVISION Mullaney explains: “Traditionally, ophthalmology is divided between Surgical Ophthalmologists and Medical Ophthalmologists / Community Ophthalmic Physicians. Surgical Ophthalmologists operate in theatres, while Medical Ophthalmologists would do non-surgical procedures and clinical work. “Many of the Medical Ophthalmologists throughout the country have been spending considerable time on what we call refractions – children’s and adults’ glasses prescriptions. We reasoned that if we were able to bring an Optometrist into the service, then we would be able to use the Optometrist to do the glasses prescriptions and that would free up the Medical Ophthalmologists to support us in tackling outpatient appointments.” The new model of care from Sligo University Hospital, working in conjunction with community health services, has redefined the pathway of care for patients and ensured that the role of each specialist is optimised within the service. The initiative builds on the success of the

NATIONAL CLINICAL PROGRAMME FOR OPHTHALMOLOGY – BUILDING A BETTER HEALTH SERVICE The number of people in Ireland with sight loss is projected to increase substantially as the overall population ages. Both Irish and international data indicate a marked increase in the frequency of blindness and vision impairment with advancing age. The National Clinical Programme for Ophthalmology is working to increase overall capacity and access to specialist services for people with eye conditions by rebalancing the delivery of care to a more communitybased model. Ultimately this will result in a reduction of the numbers being referred to specialist care and reduced waiting times for eye care. Key objectives of the programme, led by doctors, nurses and therapists, are to improve cost effectiveness and provide equitable access to efficient, high-quality care, supports and treatment. These also include the development of protocols for patient referral. Over the past year the programme has focused on a joint review with the Primary Care Division on Primary Eye Care Services, concluding in the publication of a report and recommendations for the future delivery of service in line with the strategy and model of care developed by the National Clinical Programme for Ophthalmology. Visit www.hse.ie for further information and use the Search Box to find National Clinical Programmes and select Ophthalmology

27 April 2016 | Irish Independent

award-winning Medisoft Project (the introduction of an ophthalmic electronic patient record, which enables community Optometrists to follow-up, in their local practice, those patients who have had cataract surgery, thus avoiding the requirement for the patient to come back to hospital for their review appointment). Optometrists are focusing on refraction eye tests, while Medical Ophthalmologists have become an integral part of the clinical team seeing new referrals from GPs, Public Health Nurses and Optometrists – thus enabling surgeons to focus on surgical/theatre work within the service. As a result, 1,400 additional outpatients have been seen in 2015 alone, reducing the number of patients waiting by 45 per cent. Moreover, the change in focus from the Community Ophthalmic Veronica Jasmin Pompacata Puppo having a logmar vision test completed by Marie Feeney from the ophthalmology team Physicians and freeing up the Consultant Surgeons have resulted in 850 additional day Service,” says Frank Morrison, General Manag“We have reduced our general outpatient cases within the service. The initiative avoided er, Primary Community Continuing Care, Sligo/ waiting list now to a matter of weeks, which is the need to send out hundreds of patients to the Leitrim/West Cavan. “We have been able to have very respectable. And not having to send patients private sector last year; the previous cost for this a proper division – the Ophthalmic Surgeons are out to the private sector – away from their local was €750,000. A single waiting list across comable to deal with the surgical side of things and hospital – is also a big thing.” munity and acute services is nearing completion our Medical Ophthalmologists are able to deal Mullaney is delighted the project has become and a single administrative team will manage the with the medical side. one of the finalists in the Health Service Excelreferral process. This also means that patients “Because of the breakdown like that, it has lence Awards. referred are directly scheduled into the most allowed for a lot more people be seen through the “We get a lot of validation from our patients appropriate clinic for their needs, thus avoiding system.” on a day-to-day basis – and that in many ways is duplication and unnecessary clinic visits. more of an affirmation than winning an award,” The improvements have been realised as a OVERCOMING CHALLENGES he says. “But it’s beginning to intrude on my result of a strong commitment on the part of “Whenever there’s a change in the organisation, conscious now that this is a validation, this is a big the hospital and community teams (including there are challenges,” says Fidelma Kerins, CNM thing.” clinicians, nurses, administration, IT profession2 (Clinical Nurse Manager) with Sligo University Morrison adds: “It’s a delight and an honour. I als and management), working together in a truly Hospital’s Ophthalmology Service. “But a lot think it helps to reassure patients that they are integrated approach to continually improving the of work has been put in by the team here and benefitting from having the right people with the service to patients. the teams in the community to overcome those right skills in the right place, at the right time. “It has streamlined the Ophthalmology issues and work for the best interest of patients. “We must be doing something right!”

Front row Yvonne Scanlon, Darren McAteer. Back row left to right Rachel Johnson, Lisa King, Phil Mulcahy, Mary Gilheany, Carol Boland, Yvonne O’Brien, Geraldine O’Hara, Melloney Callaghan, Fidelma Kerins, Maeve Walpole, Brid Brady, Jo Shortt

Health Service Excellence Awards | 7

National Clinical Programme for Acute Coronary Syndrome

Improving treatment for heart attacks The Acute Coronary Syndrome Programme is ensuring patients suffering from a STEMI (major) heart attack have direct access to standardised, high-quality services in designated centres around Ireland

nternational evidence shows that an emergency procedure called Primary Percutaneous Coronary Intervention (PPCI), also referred to as an angioplasty, is the most effective treatment for STEMI patients, if the PPCI centre can be reached within 90 minutes of diagnosis. PPCI involves the insertion of a wire into the artery to open it using a balloon, to allow the blood to flow to the heart muscle again. The Acute Coronary Syndrome (ACS) programme has been responsible for PPCI being rolled out nationally and results show a major shift towards the treatment of STEMI patients with PPCI in Ireland. “In 2011, we had information from most hospitals which told us that about half of patients were getting a thrombolytic drug to dissolve the clot and the other half were having angioplasty,” says Dr Siobhan Jennings, Consultant in Public Health Medicine and Member of the ACS programme. “Our most recent findings show that now 92 per cent of eligible patients get angioplasty, which is the direct removal of the clot. “This means that with a rapid response to a blockage of the coronary artery, the heart muscle is salvaged – which for patients means a quick removal of the clot, a quick return home and subsequent return to work. It also means a reduction in the risk of a further heart attack as well as lower death rates in these patients.” As well as attaining 92 per cent nationally, high rates of PPCI (angioplasty) have been achieved in all PPCI centres in 2014, reflecting change equally across the country. What’s more, this high level of PPCI compares favourably with England (97 per cent) and Wales (72 per cent), as does the crude in-hospital mortality rate of 5.9 per cent. IMPROVED RESULTS How is the ACS programme delivering such good results? Under the programme, STEMI patients, who are within 90 minutes’ travel time of a designated PPCI centre, are brought straight to a dedicated centre by ambulance, where they receive emergency PPCI treatment in the cardiac catheter laboratory.

Prof Kieran Daly, Consultant Cardiologist and National Clinical Lead of the ACS programme; Dr Siobhán Jennings, Consultant in Public Health Medicine; and Brendan Cavanagh, ACS Programme Manager

An important feature of the programme is that ambulances are now equipped with 12-lead electrocardiogram (ECG) machines and paramedics have been trained to diagnose a major heart attack. Once a STEMI patient is identified and drive time to the PPCI centre is less than 90 minutes, the ambulance crew immediately initiate transport there.

Emergency Aeromedical Service support is available when a patient is further away than the 90-minute travel window. The EAS helicopter will get many of these patients to a PPCI centre very rapidly. “There are six nominated centres in the country, which have teams on-call who deal with these patients as they arrive,” explains Professor Kieran

Daly, Clinical Lead for the National Clinical Programme for ACS. “Five of these teams are on-call 24/7 and one centre is operating on a 9am-5pm, Monday to Friday schedule. Our new standardised protocols have had a huge impact in terms of early recognition, rapid transfer and rapid treatment of patients with an acute heart attack.” A novel mechanism for monitoring perfor-

PATIENT STORY Michael Delorey, Carrick-on-Shannon, Co Leitrim I have no family history of attacks, I never smoked and wasn’t a big drinker, which is why I never thought the chill on my shoulders and an unusual taste in my mouth were symptoms of a heart attack. I was putting it down to side effects of new medication I had started the previous week. But I was feeling unwell enough to go to my local GP surgery, where Dr Trish Noonan ordered an ECG. I remember when the results of the ECG came through a few minutes later, the doctor started making a flurry of phone calls and I was told I was having a heart attack. In a matter of minutes, I was in an ambulance on the way to the local GAA pitch with a Garda escort, where a helicopter was waiting to take me to Galway University Hospital. Once in the helicopter, the crew members introduced themselves, put a headset on me so we could hear each other, and set me up with a morphine drip as I had started getting pains.

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They gave me a blanket because in all the haste my coat was left behind in the GP surgery! By the time I got to the hospital in Galway, the pain was up at around a 6 or 7 on a scale of 10. I remember the consultant cardiologist, Dr Briain MacNeill, giving instructions while cutting off my shirt. My heart was beating irregularly – and I was given a sedative before getting the electric shock. An angiogram (an x-ray of blood vessels) was done on my right arm before I went on to have angioplasty. After one night in Intensive Care in Galway, I was transferred by ambulance to Sligo University Hospital, where I was attended to by consultant cardiologist, Dr Donal Murray, who discovered and treated a clot in my left ventricle. I was in hospital for ten days recuperating before starting cardiac rehabilitation, which I attended on a group basis, run by nurse Ann McGowan. Before the heart attack I carried a bit of extra weight and I didn’t really do much physical

activity. Now I walk 5k five times a week, and I’ve lost weight. I am getting there. I don’t wake up every day thinking I’m going to die. The whole process is amazing. It’s a brilliant

service; it works because it saves time, bed hours, staff and resources. I was only in the bed one night in hospital in Galway. I have nothing but the height of praise for the HSE.

Irish Independent | 27 April 2016

National Clinical Programme for Acute Coronary Syndrome

Advanced Paramedic Joe Browne with paramedic Darren Kelly

mance of the programme has also been set up, known as HeartBeat Portal, with PPCI centres recording data on patients brought directly or referred from surrounding general hospitals. Hence, performance at PPCI centres reflects the hinterland served, the response of the National Ambulance Service as well as the functioning of the centre. NEXT STEPS The next set of challenges is to maintain the service

in the existing PPCI centres, ensure sustainable data collection in all centres to assist continuous improvement, and finalise full ECG transmission. At the same time, public awareness needs to be addressed so that people concerned about acute symptoms call the emergency service (dial 999 or 112) rather than go to the nearest hospital. The Health Service Executive, including the National Ambulance Service and PPCI centres, as well as the Irish Cardiac Society (under the

auspices of the Royal College of Physicians of Ireland), have been pivotal to the success of this programme. In 2016, a new cross-border development will ensure that Donegal patients suffering from a STEMI heart attack have direct access to services in Altnagelvin Hospital in Derry. This will represent a big saving in terms of treatment time and also distance, as well as delivering better outcomes for patients.

What is a STEMI heart attack? The heart is a muscular bag which squeezes to pump blood around our bodies. Like all muscles it has its own blood supply and the coronary arteries are responsible for bringing blood to the heart muscle. These arteries can become damaged from the build-up of plaques on the inner surface of the arteries. If a break occurs in one of these plaques, a blood clot forms in the artery and blocks off the blood supply to some of the heart muscle. If this occurs, the muscle gets damaged and this is called a heart attack. The medical term for this type of heart attack is ‘ST elevation myocardial infarction’ or STEMI for short. What is Primary Percutaneous Coronary Intervention (PPCI)? PPCI, commonly known as coronary angioplasty or simply angioplasty, is a nonsurgical procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease.

27 April 2016 | Irish Independent

Advanced Paramedic Joe Browne performing a 12-lead electrocardiogram (ECG). Ambulances are now equipped with 12-lead ECG machines and paramedics have been trained to diagnose a major heart attack and to transport patients to the best place for appropriate care

NATIONAL CLINICAL PROGRAMMES – BUILDING A BETTER HEALTH SERVICE The Clinical Strategy and Programmes Division of the HSE is focused on bringing clinical leadership to the heart of the decision-making process, with the ultimate aim of improving quality, access and value for healthcare in the country. The 33 National Clinical Programmes (NCPs) and their supporting initiatives have been one of the most significant, positive developments in the Irish health service in recent times. They have changed, and continue to change, how care is delivered, using evidence-based approaches to system reform. The NCPs have provided a foundation of valuable learning on the need to maintain and enhance clinical leadership and develop clinical pathways that are truly patient-centred. To this end, the NCPs are now evolving into Integrated Care Programmes. The overarching goal of the Integrated Care Programmes is to ensure that the health service is able to provide personcentred, co-ordinated care to all its users. Visit www.hse.ie and use the Search Box to find National Clinical Programmes

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‘Start Smart’ – Improving the quality of empiric antimicrobial prescribing at Temple Street Children’s University Hospital

How do you change an embedded culture? For Dr Rob Cunney, Consultant Microbiologist at Temple Street Children’s University Hospital, and Michelle Kirrane, Senior Clinical Pharmacist (paediatric and antimicrobial), Temple Street, it’s about face-toface engagement with frontline staff and promoting better outcomes

irrane and Cunney spearheaded an initiative at Temple Street to raise compliance with antibiotic prescribing guidelines for children admitted via the Emergency Department. From January to March last year, the pair, working with disciplines across the hospital, were able to raise compliance from 30 per cent to 100 per cent. Infection is the most common reason that children are admitted to hospital, and it is crucial that children who have infections requiring antibiotics get the right drug at the right dose – to ensure a speedy recovery, while reducing the risk of drug side effects and antibiotic resistance. “We found that a lot of times antibiotics were not being prescribed in line with the guidelines,” explains Cunney. “So, we decided to take an approach called ‘frontline ownership’. This is exactly what it says on the tin: getting the people who work on the frontline, who are actually prescribing antibiotics, to take ownership of the problem, and come up with solutions.” ENGAGED Cunney elaborates: “One key to success was that we came up with a way of measuring how well people were doing in terms of following the guidelines, and then we fed that information back to the prescribers themselves every week at the Monday morning medical handover meeting. “That started to get people engaged – realising this is actually our data, our prescribing habits that we’re looking at. After a couple of weeks, from people seeing the data every week, they started to ask, how are we doing? And that’s when Michelle and I knew we had them hooked.” The prescribers’ competitive nature kicked in, says Kirrane: “Everyone wanted to achieve 100 per cent.” Some new elements that were introduced, based on ideas from frontline staff, included making updates to prescribing guidelines more easily available, guideline summary cards attached to

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Changed for ID badges, and guideline summaries at the point of prescribing. Nursing staff in the Emergency Department, Neonatal Ward, and the ICU were given access to quick reference cards so that medication prescribed could be checked easily and they could provide further feedback to prescribers. THE PERSONAL APPROACH “We also held spot quizzes,” says Kirrane, “which again really appealed to the competitive nature of our prescribers. It’s important to recognise and celebrate success, so we did have some little

rewards along the way – boxes of chocolates and things like that, but these weren’t necessary for engagement, just an added bonus! “One of the really important parts was the personal face-to-face approach; we were there every Monday at the meeting that was being held – we’d go through the data and relate it back to patients: these are children that are currently in our hospital, and we want to make sure they’re getting the right treatment. That personal approach made a huge difference, rather than just having data or figures coming across in an email. I don’t think it’s any one intervention that was key to the success

but more the combined team effort for the benefit of our patients.” The true success of the initiative is that the change has been permanent – compliance has stayed at 100 per cent since March 2015. Cunney says: “This is tremendous because it indicates that there’s actually been a culture change. We’ve had to do very little to keep it going. In that timeframe there have been three changeovers of junior doctors and yet they’re all following the guidelines, using the reminder cards, because that’s the way things are done here now.

Irish Independent | 27 April 2016

‘Start Smart’ – Improving the quality of empiric antimicrobial prescribing at Temple Street Children’s University Hospital

KNOW WHEN ANTIBIOTICS ARE NEEDED – BUILDING A BETTER HEALTH SERVICE Misuse of antibiotics threatens to undermine the progress that has been made in medicine over recent decades. The overuse of antibiotics makes patients less likely to respond to treatment and is contributing to a rise in infections caused by so-called superbugs, like MRSA. Taking antibiotics when they aren’t needed means that they might not work when you really need them. The HSE is aiming to raise public awareness on the correct use of antibiotics to preserve this precious resource for future generations. The HSE, in partnership with pharmacists and general practitioners, has developed a website – www. undertheweather.ie – which gives practical, common-sense advice and information on dealing with many common illnesses that do not require antibiotics, like colds, flu, earaches, sore throats, tummy bugs and rashes. Antibiotics have transformed modern medicine; before antibiotics, common injuries such as cuts and scratches that became infected could result in death or serious illness because there was no treatment available.

good “We’ve also seen secondary benefits – we’ve saved money, for instance. We knocked about €105,000 off of the antibiotics budget for last year.” THE FUTURE For Cunney and Kirrane, the project has piqued their interest in terms of other quality-related improvements that could be made. “It’s made people much more aware of the possibilities in terms of doing improvement projects,” Cunney suggests. “People think, we’ve managed to do this, now what else can we do?

27 April 2016 | Irish Independent

By misusing antibiotics, we face the risk of returning to the pre-antibiotic era. Antibiotic prescribers like doctors also have a role to play. A specialist website – www. antibioticprescribing.ie – is a useful tool for health professionals and provides a simple ‘best guess’ approach to the treatment of many common infections. So remember: π Antibiotics should be used only as prescribed and when needed π Antibiotics don’t work for many common ailments – visit www.undertheweather.ie for advice on how to get better or ask your doctor for advice if you are concerned π Antibiotics should be taken exactly as prescribed – at the right time for the right duration π Always finish an antibiotic course – even if you feel a lot better – so that all the bacteria are killed and no survivors are left that could multiply and develop resistance Visit www.undertheweather.ie for further information

Top: Dr Rob Cunney; Above: Michelle Kirrane

It’s fostered a real ‘can do’ culture – which was there already in Temple Street, but this has given people a vision of how things can be achieved.” Kirrane and Cunney are already sharing what they’ve learned with other hospitals. Cunney describes the next steps: “We’re setting up a project over the next six months, in conjunction with the Royal College of Physicians of Ireland and the HSE Quality Improvement Division, where we’ll be recruiting teams from hospitals around the country to try and replicate this approach. The likelihood is they will come up with different things in terms of what will work for them locally, but it’s taking that ownership approach as a starting point.” On being nominated in the Health Service Excellence Awards, Kirrane says: “It’s amazing. Getting the recognition really makes me realise the value of our work and will hopefully help with spreading awareness of the project, inspiring us and others to want to do more in terms of quality improvement for our health service and our patients.” Visit Temple Street’s website at www.cuh.ie

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South / South West Hospitals Group / CHO 4, Regional Community Epilepsy Outreach Service

Bringing the service to the service user

Sometimes the finest ideas are the simplest. When Dr Daniel Costello, Consultant Neurologist/Epileptologist at Cork University Hospital, realised that his patients with intellectual disabilities – who were also experiencing epilepsy – couldn’t come to him, he decided to go to them

“A

significant proportion of individuals with intellectual disabilities also experience epilepsy, around 30 or 40 per cent,” explains Costello. “The more severe the intellectual disability, the more severe the epilepsy, generally speaking. And, the more severe the intellectual disability, the less likely that someone will be able to access epilepsy care. “Epilepsy care is usually only delivered in acute hospital settings, and it can be very challenging and distressing for someone with an intellectual disability to visit the hospital. They might not understand why they’re there. Sitting in a waiting room for a long time with people they don’t know – they can become very frightened and anxious. They may not get the care they need because it is too distressing to come to hospital.” A Community Epilepsy Outreach Service, based in Cork, was established in 2014, to provide high-quality specialist care to people with intellectual disabilities living in residential care. Costello and an Epilepsy Registrar, Dr Ronan McGinty, visit clients in their residential environment and provide ongoing telephone-based care between visits. The service currently visits 10 residential sites on a rotating basis, and over 200 clients have been assessed to date. The sites are run by the HSE’s St Raphael’s, Cope Foundation and Brothers of Charity. The service has succeeded in transforming the quality of epilepsy care through a radical redesign of the care model. MAKING A DIFFERENCE Thirty-seven-year-old Clive Condon was born with severe brain damage, resulting in profound intellectual and physical disabilities. A resident of the Cope Foundation, Clive is nonverbal, and can’t move on his own, requiring assistance to perform his everyday tasks. Clive also has epilepsy.

Left to right: Michael O’Brien, Clinical Nurse Manager 1, Cope Foundation; Janice Long, Cope Foundation resident; Dr Daniel Costello, HSE Consultant Neurologist/Epileptologist. Photo credit: Angela Halpin

Clive is doing very well these days – last summer, he came home for a visit after more than 20 years. Another visit is planned for May, when his sister will be back from Australia and brother from England. Clive’s mother, Eleanor, says that the Epilepsy Outreach Service has made a huge difference to them. “It can be so hard having to get an ambulance for Clive to bring him to hospital for his appointments. He’s in an environment with people he doesn’t know. He gets so stressed. This service is a miracle.” Michael O’Brien, CNM 1 (Clinical Nurse Manager) with the Cope Foundation, comments on the benefits of the service for patients and staff: “The great aspect of it is that people can be seen in their home environment, without stressing them by taking them into an acute hospital. I also have a direct telephone link to a neurologist if one of our service users is having difficulties. “The number of staff hours that we’ve lost by

taking people to external clinics has dramatically dropped off.” O’Brien’s Cope Foundation colleague, Geraldine O’Donoghue, CNM 1, adds that the continuity of care has greatly improved. Clients see the same doctors on a regular basis, whereas in a hospital they might see a new doctor at every visit – and their story would have to be explained again and again: “Our service users get to know the neurologists, they’re not just a number. “The big benefit from our point of view as staff is seeing the benefits to the patients – that’s what you strive for, to give the best service that’s possible. The service users have all had a positive experience.” Another resident of Cope, Sharon Foley, confirms this, saying that the visits of Drs McGinty and Costello are “much better” than having to go to a hospital. SIMPLY EFFECTIVE “We’ve tried to keep the service as simple as

possible,” says McGinty. “We’re able to see people in the living area, in the kitchen area, in their bedrooms. And we can take as much time as the person needs.” “Our service is essentially the equivalent of the GP house call,” says Costello. “It’s not a fanciful idea, but it works.” The benefits aren’t limited to reduced patient distress or cost-savings from residential care staff not having to travel with clients to appointments. Multiple individual cases of improved seizure control, effective anti-seizure drug rationalisation, and avoided unnecessary hospital admissions have been observed. “I would hope we can replicate this model across the country,” says McGinty. “Being nominated in the Health Service Excellence Awards is a massive boost for the work that’s been done by the whole team. “Anything that can shed light on good practice, on things that are working, can only be a good thing.”

NATIONAL CLINICAL PROGRAMME FOR EPILEPSY – BUILDING A BETTER HEALTH SERVICE

Left to right: Dr Ronan McGinty, HSE Community Epilepsy Registrar; Sharon Foley, Cope Foundation resident; Geraldine O’Donoghue, Clinical Nurse Manager 1, Cope Foundation; Dr Daniel Costello, HSE Consultant Neurologist/Epileptologist . Photo credit: Angela Halpin

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The Epilepsy Care Programme has a vision for the transformation of epilepsy care in Ireland: to provide the best patient-centred care for all people with epilepsy in the right place, at the right time, sharing the best available information People with intellectual disability frequently have the most difficult-to-control forms of epilepsy. There are particular needs in this group that require special consideration. The Epilepsy Programme is supporting the development of a coherent and expert outreach service, which vastly improves the experience of those with intellectual disability who otherwise have to attend hospital outpatient clinics or alternatively have limited or no access to

specialist epilepsy services. The Epilepsy Programme recognises the specific needs of this group and to this end, has representation from a physician working in the area of intellectual disability on the governing body of the programme, the Clinical Advisory Group. This ensures that the needs of those with intellectual disabilities who have epilepsy are reflected in all core recommendations of the programme. The outreach service in Cork University Hospital is replicated in other areas across the country with outreach provided to Daughters of Charity and Cheeverstown. Visit www.hse.ie for further information and use the Search Box to find National Clinical Programme for Epilepsy

Irish Independent | 27 April 2016

People in the health service working together to make improvements that matter Joe Ryan, Acting Head of System Reform, talks about supporting improvements in the health services

ear on year, staff in the health service provide more care and more support to people across Ireland. From advice on staying healthy or managing chronic illnesses like diabetes or arthritis, to providing ongoing care in residential settings or acute care in hospitals. Everyone working in the health services has a common goal; to provide the best service possible to users. The HSE Service Excellence Awards projects show the enthusiasm and appetite across the health services to test new ways of working that can lead to real improvements in the health service to the benefit of those we care for. As the needs of the population change and demand for health services grows, innovating new and better ways of working is an important step towards ensuring we can meet those needs into the future. The HSE is committed to learning how to do things better for patients, and whilst we have ongoing challenges, we can find ways to build on the great work that happens across the health service, as shown by the Health Service Excellence Awards projects. Improving the health service is an ongoing process with much work already underway both in frontline services and in putting in place the systems and structures to support change and improvement in how health services are delivered in Ireland. Putting in place new models of care and improving existing ones is well underway in the Clinical Programmes. We are also putting in place new organisation structures that will support the delivery of models of care the meet patient and service user needs. The establishment of Hospital Groups and Community Health Organisations is a significant

27 April 2016 | Irish Independent

step in bringing decision-making in health services closer to the user and ensuring that at every stage of healthcare delivery we have the user at the heart of our health services. We are also delivering significant reforms in the systems needed to support the health service, such as finance, technology and HR. The recently published People Strategy focuses on how we can better support our staff to be the very best that they can be, while the eHealth programme is developing technology-enabled solutions to bring improved population wellbeing and to improve day-to-day working and information flows. Our values of care, compassion, trust and learning, which are evident every day in our health services, will guide us in making the changes needed to deliver real and lasting improvements in health for the benefit of those we serve. But this will take time. A great health service is one where people’s needs are listened to, understood and catered for; it takes time and resources to be able to do this. The Health Excellence Awards projects reinforce that a great health service is most of all about people; people who understand the services best – our patients and service users, their carers and families, our staff, unions, our health partners in the third sector, in government and elsewhere – working together to deliver and improve care for those who need it. The Excellence Awards showcase what is best about our health services. They should inspire and encourage individuals and teams all around the country to work together to deliver better outcomes and experiences for service users. For further information on reform of the health service contact joe.ryan@hse.ie

Dr Áine Carroll, National Clinical & Integrated Care Programmes, on recognising the importance of the innovation and successes of the finalists The submissions to the Health Service Excellence Awards are testament to the delivery of exemplary standards of service in health and social care. The expertise, innovation, drive, care and compassion demonstrated by the teams have directly benefitted service users and patients by providing improved experiences and outcomes. Some of the entries echo the aim of the National Clinical Programmes, which is to improve and standardise patient care regardless of geography, by bringing together clinical disciplines and enabling them to share innovative evidence-based solutions in the interest of better patient care. There are over 33 National Clinical Programmes (NCPs) and many supporting initiatives tasked with improving specific areas within the health service. This is achieved through developing clinically led, standardised models of care, guidelines, pathways and associated strategies for the delivery of clinical care. The NCPs are working collaboratively with service divisions to deliver integrated care, putting the patient at the centre and ensuring that patients and clients receive a continuum of diagnostic, care and support services, according to their needs over time and across different parts of the health system. To this end, the HSE’s Clinical Strategy and Programmes Division is leading a programme of work for the establishment

of integrated care programmes for older persons, chronic disease, children and patient flow. The seven shortlisted finalists in the Health Service Excellence Awards have demonstrated exemplary and inspirational work, testament to the fact that person-centred, co-ordinated care can become a reality in our movement towards integrated health and social care services. Innovations like those highlighted here are one way we can work towards an integrated and person-centred care system. In the longer term, the challenges we face in making widespread changes at scale are not insignificant but these submissions are an assurance of the possibility. Meeting the needs of today’s ageing population essentially means we must continue to drive the change necessary to meet its requirements. In addition, given our increasing life expectancy, the changes must address other requirements which will frequently involve care for multiple medical and long-term conditions. In reality, however, a person’s needs will go beyond medical care to encompass mental health support, mobility support, and additional social requirements, such as suitable housing and other care in the community, all of which are clearly demonstrated in our final seven shortlisted initiatives. Our services have got to adapt to meet this change – not changing is not an option.

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Shortlisted Projects, 2016 Heal Thirty-nine projects were invited to make presentations detailing their project aims and objectives. Here are the seven finalists, seven highly commended projects and the remaining shortlisted all which have made a lasting impression on our health and social services National Integrated Medical Imaging System (NIMIS) team members from L-R: Peter Smith, Ann Ramsbottom, Damian Duffy, Keith Morrissey, Lisa Morrin, Breda Matthews, Mark Gilvarry (team members missing from photo: Yvonne Goff, Neil O’Hare, Sharon Flatley, Julie Bellew)

Zane O’Hoistin, Jason Collins-Mullen and Beni Shamavu, enjoying a game of wheelchair football at the Family Summer Wheelchair Camps, Co Louth. Photo credit: Barry Hunt

The Projects of the Seven Finalists

Highly Commended Projects

Sligo University Hospital/Sligo Leitrim West Cavan CHO Ophthalmology Service “Having the Right People with the Right Skills in the Right Place, at the Right Time” The Ophthalmology Service in Sligo University Hospital joined forces with colleagues working in the community to create an improved model of care for patients.

National Clinical Programme for Acute Coronary Syndrome (ACS)

Acute Coronary Syndrome Programme The National Clinical Programme for Acute Coronary Syndrome (ACS) was initiated in 2010 to save lives by standardising the care of ACS patients across the country as a joint venture between the Irish Cardiac Society (under the auspices of the Royal College of Physicians of Ireland (RCPI) and the Health Service Executive.

South/South West Hospitals Group/CHO 4 Community Epilepsy Outreach Service A Community Epilepsy Outreach Service, based in Cork, succeeded in transforming the quality of epilepsy care for service users through a radical redesign of the model of care.

Paediatric Occupational Therapists, Co Louth Family Summer Wheelchair Camps Paediatric Occupational Therapists in Co Louth found that summer camps in the county were not suitable or the facilities were not accessible for children in wheelchairs. They created a summer camp specifically designed for this group which would also meet the goals of their service.

HSE’s Mental Health and Communications Divisions Little Things Mental Health Campaign Little Things is a positive mental health campaign created by the HSE’s Mental Health and Communications Divisions and 32 partner organisations. One of the strategic priorities of the Mental Health Division is to promote positive mental health and to reduce the loss of life through suicide.

HSE Primary Care Services, Dublin North Community Virtual Ward in North Dublin HSE Primary Care Services in Dublin North worked with gerontology services in Beaumont Hospital, the Nursing and Midwifery Planning Development Unit Dublin North (NMPDU) and Royal College of Surgeons in Ireland (RCSI), to create the country’s first Community Virtual Ward for Older Persons.

Temple Street Children’s University Hospital, Dublin

‘Start Smart’ – Improving the quality of empiric antimicrobial prescribing at Temple Street Children’s University Hospital Doctors and pharmacists at Temple Street in Dublin worked together to achieve 100 per cent compliance with antibiotic prescribing guidelines for children admitted via the Emergency Department.

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CHO Area 1

Donegal Social Prescribing for Health and Wellbeing A structured programme which linked people with holistic, local, non-clinical projects and programmes and social supports in their community in order to improve their health and wellbeing.

St Vincent’s University Hospital

Community Medicine for Older Persons Nursing Home Liaison Service A project established to meet the needs of a growing number of people requiring longterm care in both public and private nursing homes.

Office of the Chief Information Officer, HSE National Integrated Medical Imaging System (NIMIS) NIMIS connects all public hospitals to enable closer collaboration between clinicians and allows secure, electronic sharing of images between specialists for faster and improved diagnosis.

CHO Area 8 – Longford/Westmeath Transition to Secondary School Group (for Children attending SAT or CAMHS services) A project which prepares children for secondary school – they may have a diagnosis such as language delays, autism spectrum disorders, attention deficit hyperactivity disorder or intellectual disabilities.

South/South West Hospitals Group

Stroke Rehabilitation & Recovery: collaborative efforts of HSE & Cork Stroke Support Group improving patient outcomes The Cork Stroke Support Group provides education, support and social contact for people who have experienced stroke and for their family and friends. The project was initiated in St Finbarr’s Hospital by the Advanced Nurse Practitioner in Rehabilitation of the Older Adult.

Safetynet methadone treatment service for homeless people, Inner City Dublin Bringing methadone treatment to homeless people This unique inner Dublin city programme has increased access to treatment by designing services to fit the particular needs of homeless service users rather than requiring them to fit into the established system.

CHO Area 3

Partnership for Health Equity Clinics in Limerick City A project set up to improve access to primary care for marginalised groups locally, including the homeless, drug users, sex workers, migrants and refugees.

Irish Independent | 27 April 2016

lth Service Excellence Awards

Partnership for Health Equity event, 2015, Tom Flynn, St Vincent de Paul; Minister Jan O’Sullivan; Maurice Hoare, HSE Social Inclusion; Rachel Conway, Ana Liffey Project; Dr Patrick O’Donnell

Pictured L - R Joan Naughton, Clinical Nurse Manager St Joseph’s Day Hospital; Dr Alan Martin, Consultant Geriatrician Beaumont Hospital and Maureen Morris

Remaining Shortlisted Projects

Safetynet Primary Care Network for Homeless Health Services Safetynet Mobile Health Unit for Rough Sleepers A project designed to increase access to primary care among homeless rough sleepers and awareness of social justice among GP registrars. Rehabilitative Training Unit, National Rehabilitation Hospital Next Stage Rehabilitation Programme A national service designed for people who have an acquired brain injury (ABI). The aim of the programme is to assist individuals in learning the necessary life, social and work skills to return to their maximum independence and functional ability. St Vincent’s University Hospital, Elm Park, Dublin Improving the Recognition of Palliative Care Needs of Patients attending the Emergency Department Systems were developed and audited for the rapid referral of patients for palliative medicine within the Emergency Department at St Vincent’s Hospital. Cork University Hospital/Marymount University Hospice Interventional Pain Service The Interventional Pain Service based at Marymount University Hospice provides rapid access to patients suffering from cancer pain. It is the result of collaboration between specialist palliative care, medical oncology and pain relief services at Cork University Hospital, South Infirmary Victoria Hospital and Marymount Hospice. CRC Modified constraint induced movement therapy (mCIMT) in preschoolers with hemiplegic cerebral palsy A programme to evaluate mCIMT as a home intervention to improve upper limb function in preschool children with a diagnosis of hemiplegic cerebral palsy. National Ambulance Service National Ambulance Service Reconfiguration Project This project involved the role of a new two-way radio digital communications system which would ensure voice and data communications between an ambulance call-taking dispatch centre and operational crews. National Counselling Service, Castlebar and PCCC Psychology Service A Stone Unturned: A Guide for Families of Children who Have Experienced Sexual Abuse A publication providing information and guidance to families in Co Mayo dealing with the reality of child sexual abuse in their families. University Hospital Limerick Hospital Group Implementation of Malnutritional Universal Screening Tool The screening tool was implemented into the UL Hospital Group. It is used to identify patients with possible malnutrition to allow the efficient targeting of resources for nutritional assessment.

27 April 2016 | Irish Independent

National Clinical Programmes for Trauma and Orthopaedic Surgery and for Rheumatology Musculoskeletal Physiotherapy (MSK) Physiotherapy Initiative Clinical Specialist MSK Physiotherapists were employed nationally to aid clearance of lengthy outpatient department waiting lists and improve long term MSK referral management. Older Persons Services, South Tipperary The 5 Steps to Living Well with Dementia in South Tipperary A project to develop innovative, cost-effective models of care for people with dementia which support people better in their own communities and prevent their premature entry into long-term care. Multidisciplinary Guideline Development Group Irish Maternity Early Warning System This project devised a national early warning system for pregnant and postpartum women in Ireland in order to standardise care and provide a method for early detection of life-threatening illness. Health and Wellbeing Division, HSE Implementing an Integrated Management Information System in the National Newborn Bloodspot Screening Programme The National Newborn Bloodspot Screening Programme screens Irish newborns for six conditions on day four to five. As health outcomes depend upon rapid commencement of treatment, return of results is time critical. Post implementation showed a significant reduction in the laboratory reporting duration. South/South West Hospitals Group How a Cardiology Information System positively influences Cardiology Services A unique cardiology management system was developed, prototyped and tested in University Hospital Waterford to interface with medical diagnostic equipment and electronically transfer patient data and clinical images to a single data repository. Audiology Services Integrated Audiology Service This project looked at changing the care pathway from ENT (Ear, Nose and Throat) in the Mater Hospital, Dublin to Community Audiology in North Great George’s Street to speed up the time from identification of hearing loss to fitting of hearing aids. Tallaght Hospital, Dublin Patient Survey Programme Tallaght Hospital developed a comprehensive and systematic patient survey programme enabling it to capture patient feedback on a continuous basis, highlighting areas for improvement and areas that are working well.

Saolta Hospital Group Cardiac Devices Follow Up Clinic This project was initiated to provide a high quality, Cardiac Physiologist led, follow up service for patients with pacemakers, implantable cardiac defibrillators and implantable loop recorders. RCSI Hospital Group Promoting Hand Hygiene A quality improvement initiative to improve hand hygiene and reduce the acquisition of transmissible organisms such as MRSA. Naas General Hospital, Co Kildare and KARE Project SEARCH A project designed to transform employment opportunities for people with disabilities. SAGE Service SAGE – Support & Advocacy Service for Older People SAGE is working to expand access to support and advocacy services in all care settings and wherever ageing poses a challenge for individuals. Mallow Primary Healthcare Centre, Co Cork The Crystal Project The Crystal Project is an innovative community dementia project which aims to support older people with dementia and increase awareness of the condition. RCSI Hospital Group ICU Foundation Programme A collaborative, multi-professional, patient-centred initiative to educate and train nurses within the speciality of critical care at Our Lady of Lourdes Hospital, Drogheda, Co Louth. South Infirmary University Hospital, Cork Acupuncture Service to treat Xerostomia (dry mouth) in Patients’ Post-Radiotherapy for Head and Neck Cancer Project to treat radiation-induced xerostomia and assess the benefits of acupuncture as a cost-effective treatment modality. National Cancer Control Programme Delivering care to oncology patients in the community; an innovative integrated approach in Ireland A programme to provide safe, seamless aspects of care to oncology patients in their own homes. Cavan Monaghan Mental Health Services WRAP Partners in Practice Implementation of a Wellness Recovery Action Plan programme within all areas of the Cavan Monaghan Mental Health Service co-delivered by staff and service users in equal partnership. Our Lady’s Children’s Hospital, Crumlin, Dublin The Poo Passport The development of tools to assess and manage children with idiopathic constipation in the community.

Health Service Excellence Awards | 15