Introduction & Description: The NRH Paediatric Programme was reviewed within the context of the decision to maintain complex paediatric neurological rehabilitation at the NRH, and the Paediatric Clinical Programme Model of Care. This framework formed the basis for a change management project within the current service to reconfigure resources and provide new ways of service delivery. The objectives of quality, access and value were key. The programme has moved to a “children served” approach and broadened the range of service options.
Aim & Theory: The project was initiated in response to key challenges to the NRH Paediatric Service including lengthy waiting lists over extended staff and unnecessary variation in patient experience. The aim was to align the NRH Paediatric service with the models of care developed HSE National Paediatric Clinical Programme and the Rehabilitation Medicine Programme.
Targeted population: The NRH PAEDS Programme remains the only service of its kind in Ireland with little change in staffing levels over many years despite a substantial increase in referrals, more complex cases and a change in international best practice on the necessity for review by a paediatric specialist neuro rehabilitation team of identified children. The populations served by this project includes not only all the children under the care of the programme but also the treating team.
Timeline: The Implementation of the Project was given a timeframe of 6 months. This was following a period of review/analysis of current systems operating within the service.
Highlights: The aligning of priorities across all stakeholders ie programmatic priorities, Organisational priorities, health services priorities, team priorities, family priorities.
Sustainability: The extensive consultation process undertaken supported multi-stakeholder collaboration and buy-in. Implementing and sustaining changes which are representative of the views of key stakeholders and accepted as best practice is more sustainable than enforcing a pathway that is not felt to be reflective of all important issues.
Transferability: The principles underpinning the changes made & the management of same within the programme are consistent with international models of improvement science and thus applicable across other service.
Conclusion: The project has already shown a reduction in waiting lists, more efficiency in terms of service delivery and greater predictability in terms of service planning. A further outcome is a reduction in unnecessary hospitalisation for children. Increased resources are being directed at integrated care via outreach and education to community services and schools.
Discussion: Quality care is care which is patient centred. To be truly patient centred, a move away from individual service priorities is required with a focus on aligning priorities to support the patient/family.
Lessons Learned: Implementation of the project required not only a change in processes, but a change in culture which underpinned the processes. Culture change requires significant investment in developing relationships with team and building trust. It doesn’t happen overnight. Hearts and minds were won when the team could see how the change facilitated the overall shared objective which was to provide the service in line with international clinical guidelines.
O'Driscoll, Edina, Anne O'Loughlin, Ghyslaine Brophy, and Amanda Carty. 2017. “Rehabilitation Without Walls”. International Journal of Integrated Care 17 (5): A536. DOI: http://doi.org/10.5334/ijic.3856
O'Driscoll, Edina, Anne O'Loughlin, Ghyslaine Brophy, and Amanda Carty. “Rehabilitation Without Walls”. International Journal of Integrated Care 17, no. 5 (2017): A536. DOI: http://doi.org/10.5334/ijic.3856
O'Driscoll, E, et al.. “Rehabilitation without walls”. International Journal of Integrated Care, vol. 17, no. 5, 2017, p. A536. DOI: http://doi.org/10.5334/ijic.3856