Delivering quality and efficiency in healthcare

At this time of year I would normally be writing a review of all the facilities and estates conferences that we had attended through the season. This year our own event has been put back from September 2010 to March 2011, partly because we felt that the autumn programme of events was getting a little congested.
    
The HefmA and AHCP events from the summer have been reviewed elsewhere and for me the focus of recent activity has been around the Healthcare Estates, British Parking Association and Scottish Healthcare conferences all held within a few weeks at the end of October and into November.

Scottish Healthcare Conference
The Scottish Healthcare Conference, held at the Crieff Hydro on 4 and 5 November 2010, looked at delivering quality and efficiency in healthcare and the programme content very much reflected this. The event provided an opportunity to gather knowledge of best practice, new techniques and technologies and to network with colleagues working in and across the estates and facilities spectrum both within healthcare systems and the private sector from across Scotland.
    
It was very interesting to note Paul Kingsmore, Director of Health Facilities Scotland (HFS), saying in his introduction to the Scottish event:

“The changes in the economic climate have had a dramatic impact on the world economies. Within healthcare we are proud of the significant achievements which we have made but now understand the challenges ahead. Money is tighter yet expectations are greater. The public rightly expect us to obtain the optimum value for money.
    
“On the positive side NHSScotland Estates and Facilities professionals and our colleagues in the private sector working with us continue to drive forward new initiatives and deliver improved facilities making important contributions to the reduction in healthcare associated infections (HAIs), reduction in our carbon footprints, delivery of new and innovative initiatives and supporting access to a wide range of clinical services.”1

Effective facilities in tough times
The programme was very much built to reflect this thinking and the important topics it generates. From plenary sessions, including one with the Minister for Public Health and Sport, through the streams and on into the exhibition, the drive for efficiency savings without compromising the good work that has been achieved over recent years was pre-eminent. As always at such events it is easy to get hit with information overload and I have tried to capture the gist of key sessions in a few phrases.

Duty of care
Shona Robison MSP, Minister for Public Health and Sport addressed what is being done in Scotland to assist the health boards in meeting their duty of care commitment to deliver facilities fit for purpose within a restrained economic environment in the context of three key areas:
•    Capital planning and effective         
      delivery of capital
•    Efficiency of delivery using asset management
•    Role of facilities management

All this within the aims of the Quality Strategy – to embed the need for well designed, sustainable and safe healthcare environments as an integral part of service delivery.
    
One point that really caught my attention was when the Minister noted: “Best practice dissemination is key in these time of austerity. Focus investment in the areas where it will have the maximum impact on the services we provide.”
    
Unfortunately the Minister had to leave immediately after her talk and so there was no opportunity for the delegates to ask her questions on some of the points of interest and particularly the more contentious issues.     
    
That noted, the talk was well received and it was refreshing to see that in Scotland the Minister was not only willing but keen to address the staff who actually make sure that healthcare premises are fit for purpose and clean and safe for daily use.

Learning from overseas
The second plenary session of the opening day was presented by Bruce Kominske, chief, new hospital design and construction at the Children’s Memorial Hospital in Chicago. Bruce spoke with obvious enthusiasm about their new development on a small footprint site in the centre of Chicago, what he described as a “vertical hospital.”2 His talk focused on the importance of creating a unique healing environment by engaging the community in the design and construction of the new hospital facilities. He cited specific examples from the new hospital where over 20 of the City’s cultural organisations, including museums, the aquarium, zoo and ballet all volunteered their creative talents. Importantly this input was at no cost to the project and has helped in the creation of a very special healing environment, if the photographs and schematics he showed are anything to go by.
    
Bruce specifically mentioned the healing impact of art and gardens and showed examples from previous projects as well as how a garden is being included half way up the new build. This can be accessed as a public area but is also overlooked by a number of the patient areas, providing benefits for those who cannot have access to the area. He also talked about the need to provide “direction and diversion in the lobby” – a phrase that came from a long term child patient’s mother. She simply made the point that to her arrival in the hospital lobby provided two requirements:
•    Direction: She needs to know where to go without having to hunt for signage
•    Diversion: Something to divert her daughter’s mind from why she is here

This has lead to a number of innovative design features being built into the reception and circulation areas on different floors including a fire engine and a mother whale with her calf. The challenge to us all has to be how we can gain the active involvement of the local communities at a very early stage in such projects, not just new build but also refurbishment. Developing such innovation in design of the healing environment with the philanthropic support of benefactors will be a very real challenge but surely one to rise to and also one which the current UK Government should be actively supporting as part of its “big society” ethos.

Infection prevention
The evening of day one saw an excellent formal dinner and charity event raising some £3,000 for Cancer Research UK and Martin Keirnan was a superb choice of speaker for the opening session of day two, as his approach certainly made sure all who made it to the conference hall were properly awake. Martin is Infection Prevention lead for Southport and Ormskirk Hospitals NHS Trust and spoke with authority on the subject of “Infection Prevention in an Era of Austerity”. His talk was informative and eminently entertaining, full of facts and also dispelling some of the fiction around HAIs. I really liked the way he even challenged his own job title – Infection Control Nurse – noting that in reality he controls nothing at all!
    
The whole conference was interesting and informative and supported by a reasonable sized and very relevant exhibition. With 48 companies and associations covering everything from automated vending to thermal imaging cameras there was plenty of new technology as well as cost effective use of current facilities and technologies to be seen.

Estates monitoring
The real benefit of such events was emphasised to me by the very last session that I attended. This was quite literally the last session of the conference, one of four streams run before lunch and because of the number of questions being asked the last to finish. The topic was ‘Estates Monitoring – Past and Present’ and was presented at short notice by Richard McManus because the planned speaker had been unexpectedly called away. The presentation was actually about the Domestic Monitoring Tool implementation programme that has been running for a number of years in Scotland using an Excel spreadsheet for the submission of nationally collected data.                 
This has been developed to include scoring of the estates elements that impact on cleaning services and some of the feedback provided was very enlightening. Looking to the future it is planned to introduce a web based system in 2012 with the use of hand held devices that link so that data re-entry is done away with.

Cleaning reports
Looking similar in approach to the project undertaken by Welsh Health Estates for the Welsh Assembly Government in 2009 and implemented this year, the objective is to provide a supported route for consistent monitoring and reporting of cleanliness throughout Scotland. Key points made were that the monitoring has to be underpinned by three core requirements:
•    Accuracy
•    Honesty
•    Integrity

Training has been provided for the staff who carry out the monitoring so that there is a consistency of approach throughout Scotland. It pleased me to see that the information that should be collected for local management and monitoring of services is going to be used for reporting to government; this should provide a high level of ownership to the data collected and thereby raise the quality of the information reported from it.

Feedback
Having noted the level of the question and answer session at the end it was refreshing to hear questions at all levels relating to the monitoring toolkit and its use. Trying to distil the enthusiasm, scepticism and high level of interest voiced in this time into a few words is very difficult; but perhaps the following will give you a feel for the level of involvement healthcare facilities teams feel for their role in supporting healthcare delivery:
    
“The collection of such information should be used to support business cases and a National Scoring regime should drive funding for business cases.”
    
“There is a need to review scoring and weighting so that higher activity and higher risk areas are correctly reflected in the reports.”
    
“Such systems must integrate with other systems used in organisations so that the information supports proper response times and does not delay responses.”
    
“It is important that one staff group is not set against another by such information reporting.”
    
The enthusiasm shown extended to some interesting conversations over lunch before the long drive home and it was particularly interesting to hear the Scottish response to the Welsh project. This has adopted Credits for Cleaning, a system originally funded by the English Department of Health to support the implementation of the NHS Cleaning Manual, as the system of choice for Wales so that all Welsh healthcare premises now use the one system for managing and monitoring cleaning services. The drive for the whole of the NHS is to keep HAIs at the lowest level possible and the concern is that the drive for savings may result in cuts to such fundamental services that result in an increase. We all have a responsibility to provide premises that are safe and clean and fit for purpose; the purpose being to provide high quality healthcare to the nation in an efficient manner.

Footnotes
1    Scottish healthcare Conference Programme – delegate introduction
2    For more information on the new hospital visit: www.childrensmemorial.org/newsroom/newhospital.aspx

For more information:
Web: www.hfc.org.uk