HSE Quality Systems

Without getting into the specifics of the incidents that are being plastered all over the tabloids the lack of standards based quality systems in the health service is still putting patients health at risk and costing the state a fortune. It seems bizarre that a doctor has been appointed head of quality for the HSE. I don’t know anything about the man but unless he has worked as a QA manager in a large private sector organisation designing and implementing quality procedures to a recognised ISO standard he doesn’t have the necessary qualifications. Being a medical doctor is at the least irrelevant and may be a hindrance.

The lack of standards based procedures around early pregnancy scans is typical of the lack of understanding of what quality management systems are in the health service. The HSE needs to produce a set of standards that every hospital must conform to. This does not mean that every hospital has to do everything the same way, it means that they must all conform to the standard. For example the standard could state “when scanning a pregnant patient in the first xxx weeks of pregnancy if an anomaly if detected the patient shall be informed that there is a concern and a second scan shall be carried out by a consultant within one week”. What procedures each hospital puts in place to make sure the standard is adhered to is up to them as long as the HSE’s external auditor is happy that they conform to the standard. It’s what’s done in every ISO company in Ireland, why not in the health service? If such systems are supposedly in place then the HSE auditors and the guys who set the standards should all be sacked.

Without getting into the specifics of the incidents that are being plastered all over the tabloids the lack of standards based quality systems in the health service is still putting patients health at risk and costing the state a fortune. It seems bizarre that a doctor has been appointed head of quality for the HSE. I don’t know anything about the man but unless he has worked as a QA manager in a large private sector organisation designing and implementing quality procedures to a recognised ISO standard he doesn’t have the necessary qualifications. Being a medical doctor is at the least irrelevant and may be a hindrance.

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+1

This is not even remotely unusual either.

It also seems bizarre that the HSE never come out and publically admit mistakes until the media breaks the story. The guy last night on Prime Time said the first he heard about it was that morning. Is it any wonder that people don't have confidence in the system. The HSE don't even seem aware of what it happening under their watch.

Purple, I agree and disagree with your post. I think it is a disgrace that there are no national standards for certain procedures, but I wouldn't say a QA manager would do a better job other than to start a process of generating paperwork.

How would someone who's QA experience is manufacturing or Pharmachem be able to develop standard procedures for health care? ISO standards amount to a certificate on the wall, the principles behind them though are fairly straightforward. I'd agree someone with an experience in developing a system is needed in an advisory capacity with a specified term relating to the development of the system, but I feel the detail of the standards are better off in the hands of someone with knowledge of medical practices.

Latrade said:

How would someone who's QA experience is manufacturing or Pharmachem be able to develop standard procedures for health care? ISO standards amount to a certificate on the wall, the principles behind them though are fairly straightforward. I'd agree someone with an experience in developing a system is needed in an advisory capacity with a specified term relating to the development of the system, but I feel the detail of the standards are better off in the hands of someone with knowledge of medical practices.

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But this is always the case with QA and even with management in general - the principles are the same. A manager who has worked in confectionary production wouldn't bat an eyelid about a move to environmental consultancy for example - and neither should their QA counterparts.

The job of the person developing the standards is to loom at how things are done in different hospitals and, with the aid of people from those hospitals, decide who is doing it best. The development of a standard is simply writing out what is currently done, kind of like a flow chart, getting everyone to agree that what they have written is correct and then writing a standard that requires the key stages of that procedure.

The key thing is to be clear and linear in developing each facet of the standards. Just as a doctor is the wrong person to run the HSE (unless he or she is also a superb and experienced administrator and manager) a doctor is also the wrong person to develop the standards. Medical staff should develop the procedures but that’s a different issue.
There is no shortage of experienced medical people to advise the Director of Quality but process driven thinking is not something that is usual amongst medical people. Talk to an accountant who does the books for a few GP’s and you’ll see what I mean.

One wonders about the abilities of an organisation charged with critically important work in the the area of health-care when it can't even correctly publish the profiles of its own board-members on its own web-site.

Do we complain to HIQA, Drumm, Harney, the HSE Quality Guru or just snigger behind our hands at this most recent of their vain attempts to sellotape over the crumbling disaster that is the HSE (still built around and reporting along the old Health Board lines, with just a newish veneer of "management" layered on top and around about it)?

I quote, before they change it "Eugene McCague is a solicitor and Chairman of Arthur Cox. He is a graduate of University College Dublin. He is a member of the Board of Co-Operation Ireland, a former Chairman of the governing body of the Dublin Institute of Technology and a former president of the Dublin Chamber of Commerce. Joe Mooney is a retired senior official of the Department of Finance where he had extensive policy involvement in the health and social welfare areas. Previously, he worked on economic and taxation matters. He is a former member of the Pensions Board." Two persons in the one divine body? Cost-cutting? Cross-functional roles? Multi-disciplinary individuals?

[broken link removed] but it'll change as soon as I post this. Quality how are you!

Caveat said:

But this is always the case with QA and even with management in general - the principles are the same. A manager who has worked in confectionary production wouldn't bat an eyelid about a move to environmental consultancy for example - and neither should their QA counterparts.

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Agreed and that does happen, that doesn't always make it the correct decision (on the part of an employer).

Certain things like accounts and other legislative areas would require competency in the legal implications, so I'd agree that some qualification and expertise is required. But outside of a handful of areas, the greater need is to understand the "business" and the operations.

Granted, it shouldn't be down to just one individual give the very differing nature and scope of the health service and I'm not entirely sure a Doctor is the best person to provide a true picture of health service operations, but I don't see the need for them to be an external person.

Their job would be to go to (e.g.) 5 different hospitals and ask the people performing a particular task in each of those hospitals how they perform that task. They then record what they do (in a flow-chart type format). Then they sit down with their advisors, who could be key people from each of those hospitals, and decide which method is best. They then tweak it and examine it for flaws and then write a procedure describing it and issue that procedure to each of the 5 hospitals. The whole process should take days or weeks but not months or years. The hard part is making sure that the overall system is integrated and there is a free flow of information but the big healthcare firms like Siemens, Phillips and GE have excellent integrated systems for that.

Alternatively the HSE should look for a standards based system which is used in another country and adopt it (changing work practices to suit the standard and not the other way around).

+1 Purple, I just don't see why it needs an external person and why someone from within the HSE couldn't do just as good a job. It should have been the first thing done when forming the HSE rather than allowing the system to still operate as the old health boards with a very expensive stationary change.

In all mergers, takeovers, etc, there are always reviews and phase in of common procedures, standards and ultimately most "shared services" end up being centralised.

Quality Standards

Any chance he'll start with maternity services and then work his way around all other clinical areas where citizens will be provided with a clear description of what a quality service should look like, setting clear benchmarks based on evidence based practice and collaboration with service users, that health providers can then aspire or progress to meet.

All they have to do is look across the water to the UK - its called the National Institute for Clinical Excellence - NICE!

One arm of it is to set quality standards. More interestingly, they also publish a comprehensive set of guidelines on various medical conditions that aims to educate and inform the public about medical conditions and their rights around treatment and what they can expect from NHS service providers that they interact with.