Why cant all hospitals be run like this

Wanderer78

blackbox wrote: »

...and this exactly reflects the failure of Irish and UK unions.

If the unions genuinely embraced change and improved productivity there would not be the same need for businesses to de-unionise.

Lots of union members in Germany along with high productivity and good pay.

In Ireland unions are focused on protecting lowest performers.

but practices are different in germany, its common for german workers to be a part of the running of companies, including being members of the board of directors. the irish union movement is stuck in the 70's/80's, they havent moved with the times at all, they have become very militant, but i think there is an element of every force creates an equal and opposite reaction, theres clearly managerial issues within our health system, but health systems are extremely complex, particularly a mixed public and private system

adocholiday

Wanderer78 wrote: »

its interesting that from the de-unionization of our economies, particularly in the private sector, productivity has risen dramatically, yet wage inflation has remained relatively low and the precariousness of employment has worsened!

It's a fair point, but a different side to the argument IMO. One of the biggest draws to the Public Sector in Ireland, and at the same time one of its major flaws, is the security of the job. Under-performers don't get pulled up, in fact they get promoted and get their increment solely based on tenure. This leads to toxic environments where you have people in management who simply are not fit to be there but can't be sacked. Then you have people in those roles who are excellent at their job but are hampered in making effectual change.

Salary stagnation is happening within most sectors, even in unionized ones but I don't think that keeping the status quo in terms of union power is the way to fix that. When unions were first established their purpose was to ensure that workers were afforded their rights, and gave them a collective voice for bargaining power and safe work practices etc. however they have long since expanded beyond that remit. Salary stagnation can be remedied by legislation, it doesn't need self serving unions holding the country to ransom when someone wants to change how patient appointments are scheduled, or a new modern IT system is introduced that might streamline patient/doctor communications. They'll say they're protesting because they're not getting adequate training or resources, but someone throws a few grand at their salaries and the original complaint disappears.

I don't mean to appear anti-union because I'm not. I am anti-whatever the unions have become. I also don't want to pull the thread off topic into a pro/anti union debate, so to address the OP's point - I just think that the unions need to be reined in massively if anyone wants to attempt to bring in changes to how the Health Service works here so our public hospitals can be as effective as the private ones.

Wanderer78

adocholiday wrote: »

It's a fair point, but a different side to the argument IMO. One of the biggest draws to the Public Sector in Ireland, and at the same time one of its major flaws, is the security of the job. Under-performers don't get pulled up, in fact they get promoted and get their increment solely based on tenure. This leads to toxic environments where you have people in management who simply are not fit to be there but can't be sacked. Then you have people in those roles who are excellent at their job but are hampered in making effectual change.

Salary stagnation is happening within most sectors, even in unionized ones but I don't think that keeping the status quo in terms of union power is the way to fix that. When unions were first established their purpose was to ensure that workers were afforded their rights, and gave them a collective voice for bargaining power and safe work practices etc. however they have long since expanded beyond that remit. Salary stagnation can be remedied by legislation, it doesn't need self serving unions holding the country to ransom when someone wants to change how patient appointments are scheduled, or a new modern IT system is introduced that might streamline patient/doctor communications. They'll say they're protesting because they're not getting adequate training or resources, but someone throws a few grand at their salaries and the original complaint disappears.

I don't mean to appear anti-union because I'm not. I am anti-whatever the unions have become. I also don't want to pull the thread off topic into a pro/anti union debate, so to address the OP's point - I just think that the unions need to be reined in massively if anyone wants to attempt to bring in changes to how the Health Service works here so our public hospitals can be as effective as the private ones.

maybe we need to work on making the private sector a little less precarious, and less stressful, but all good points otherwise

Geuze

Wanderer78 wrote: »

its interesting that from the de-unionization of our economies, particularly in the private sector, productivity has risen dramatically, yet wage inflation has remained relatively low and the precariousness of employment has worsened!

When I think about de-unionising the HSE, I am not calling for:

lower pay
less generous benefits
less generous pensions

All I want is an end to restrictive work practices / inflexible working, and protecting poor staff.

Wanderer78

Wanderer78 wrote: »

but practices are different in germany, its common for german workers to be a part of the running of companies, including being members of the board of directors. the irish union movement is stuck in the 70's/80's, they havent moved with the times at all, they have become very militant, but i think there is an element of every force creates an equal and opposite reaction, theres clearly managerial issues within our health system, but health systems are extremely complex, particularly a mixed public and private system

Geuze wrote: »

When I think about de-unionising the HSE, I am not calling for:

lower pay
less generous benefits
less generous pensions

All I want is an end to restrictive work practices / inflexible working, and protecting poor staff.

i think theres a possibility. the public sector unions behave so, as a result of the de-unionisation, and all its issues, of the private sector, maybe

GreeBo

I've seen both sides of it in the Beacon.
The procedure (whatever procedure it is!) is always efficient, but then you can spend hours waiting for the Dr/Consultant to see you before you get discharged, I've literally waited for 2 hours, sitting fully dressed on the bed for the Dr/Consultant to pop in and ask "any questions?, ok you can go".

No rush to clear the beds when the insurer is paying thousands for it.

Wanderer78

GreeBo wrote: »

I've seen both sides of it in the Beacon.
The procedure (whatever procedure it is!) is always efficient, but then you can spend hours waiting for the Dr/Consultant to see you before you get discharged, I've literally waited for 2 hours, sitting fully dressed on the bed for the Dr/Consultant to pop in and ask "any questions?, ok you can go".

No rush to clear the beds when the insurer is paying thousands for it.

theres no question, the introduction of insurance, adds extra complexity to the system

tails_naf

Dav010 wrote: »

Staffing a ED is extremely expensive, if you then provide for admissions, you have to have full time staff for all specialities plus their regs/SHO’s to provide adequate care on the wards. A large percentage of private Hospitals do not have full time consultants, the Consultants work in the Public Hospitals and do part time private sessions in private Hospitals, they are not employees. You put in an A&E and admissions and necessary X-ray cover, path lab, haematology, cleaning staff, catering, administration, costs of indemnity etc, Hospital running costs increase exponentially, €100 pp will not cover it.

The beacon (which is why I started this post) has xray and haematology, and the rest. My xray was done in under 10 mins from being requested, giving me 30 mins to grab a bite to eat, after which both my xray results and my bloods were back.

riclad

Public er has to deal with drunk people and drug addicts ,anyone who wants to go there .
Its easy to deal with a private hospital when you know all your customers
And know when they will go there by appointment .
people on private insurance reduce the load on public hospitals,
Some consultants work both in private and public hospitals .

lsjmhar

tails_naf wrote: »

I'm at the beacon hospital for a health check and they had me do an unscheduled chest xray. I went down to the radiology department, and was registered and had the xray completed in less than 10 minutes. The radiographers themselves took about 2 minutes end to end. Results automatically sent back to the health check. This is how you save money, that one xray room can see hundreds of people a day if needs be. No way, no messing. Why can't this be the way all hospitals work?

Alright Denis!! Lol

tails_naf

riclad wrote: »

Public er has to deal with drunk people and drug addicts ,anyone who wants to go there .
Its easy to deal with a private hospital when you know all your customers
And know when they will go there by appointment .
people on private insurance reduce the load on public hospitals,
Some consultants work both in private and public hospitals .

Was in A and E last night (still am), arrived at 8pm, got seen at 6am. No social distancing in the waiting room. A 10 hour wait is taking the piss, where's the 20 billion going, it sure is not A and E in Cuh!

Outkast_IRE

The elephant in the room has been and will be for the future is the fact that we are simply not training and subsequently retaining enough medical professionals in all fields.

Half the junior doctors in hospitals at the moment are foreign students who will be on their way home at the end of their training. We need to retain all we can and the current universities taking in large quantities of students from abroad hurts this enormously.

We need to be producing probably double the number of doctors and associated medical professionals each year than we currently do. The benefit of this is twofold , 1. Junior Doctors may end up having some chance at a reasonable work-life balance and not flee the country immediately on graduation. 2. We are ensuring a steady stream of future consultants so we arent struggling to fill those positions also.

It will also have the benefit of keeping wage inflation somewhat in check because we will have improved the working conditions for the doctors.

Working with Universities to double the number of places available will be money better spent than the Black Hole which is the HSE.

Dav010

Outkast_IRE wrote: »

The elephant in the room has been and will be for the future is the fact that we are simply not training and subsequently retaining enough medical professionals in all fields.

Half the junior doctors in hospitals at the moment are foreign students who will be on their way home at the end of their training. We need to retain all we can and the current universities taking in large quantities of students from abroad hurts this enormously.

We need to be producing probably double the number of doctors and associated medical professionals each year than we currently do. The benefit of this is twofold , 1. Junior Doctors may end up having some chance at a reasonable work-life balance and not flee the country immediately on graduation. 2. We are ensuring a steady stream of future consultants so we arent struggling to fill those positions also.

It will also have the benefit of keeping wage inflation somewhat in check because we will have improved the working conditions for the doctors.

Working with Universities to double the number of places available will be money better spent than the Black Hole which is the HSE.

I’m afraid it is not as simple as that.

Training health care staff is enormously expensive, foreign students pay much higher fees than Irish students, I think it was around £15k per year when I trained in the late 80’s so it is probably double that now. Universities need those fees to continue to train their students.

There are a lot of reasons why medical students decide to work abroad, among them are pay & working conditions, opportunities to get into specialist training courses and the desire after 7 years of study/internship, to see and work in a new part of the world. If you double the numbers trained without improving pay and conditions, you are just training more Drs to emigrate.

Increasing Drs numbers alone won’t improve the lot of patients, you would have to increase ancillary staff, beds, operating theatres, admin etc, there would be no point having double the number of Drs in A&E and not having beds to admittance, nurses to help, porters to move, admin, X-ray staff to take more xrays, larger building to cater for more patients etc. You really can’t take one part of the Health system and say if you changed this, everything would improve.

In relation to the ops most recent post, anyone who stands outside CUH and looks at it, then stands inside to see how busy it is and how many staff are there, and can’t understand why it would cost a lot of money to run, can’t be helped on this thread.

Obvious Desperate Breakfasts

tails_naf wrote: »

I'm at the beacon hospital for a health check and they had me do an unscheduled chest xray. I went down to the radiology department, and was registered and had the xray completed in less than 10 minutes. The radiographers themselves took about 2 minutes end to end. Results automatically sent back to the health check. This is how you save money, that one xray room can see hundreds of people a day if needs be. No way, no messing. Why can't this be the way all hospitals work?

I’ve had X-rays done that quickly in various public hospitals. X-rays are really quick. The scanning portion is almost always over in a minute or two and the registration and waiting bit is often very quickly done too. I think X-ray departments DO see hundreds of patients a day. Whenever I’m there, there’s a constant stream of people.

Hannibal_12

tails_naf wrote: »

I'm at the beacon hospital for a health check and they had me do an unscheduled chest xray. I went down to the radiology department, and was registered and had the xray completed in less than 10 minutes. The radiographers themselves took about 2 minutes end to end. Results automatically sent back to the health check. This is how you save money, that one xray room can see hundreds of people a day if needs be. No way, no messing. Why can't this be the way all hospitals work?

Unfortunately public hospitals are a much different animal. I've worked in UK and Irish hospitals and sad to say what is deemed acceptable/tolerated here is shocking.

Obvious Desperate Breakfasts

Patrick2010 wrote: »

Thanks to Covid , this has changed. Theres no more having 40 or 50 people been given an appointment for 8 o clock. You'll only have a few waiting now now, sitting well spaced out and the idea is to get people in and out asap. I know as I work in hospitals and the difference in the out patient departments is clear from pre Covid.

Sadly not. I went to see my oncologist in the outpatients department in July and was waiting for 3 hours in a hard chair. I complained loudly about it. If they’re not going to do anything to better organise the appointment system, they’re at least going to hear about it.

I’m continually appalled at how badly cancer patients are treated. Many of them travel far to be there, many are on exhausting treatments, many are elderly, many of us have numerous aches and pains. I’ve sometimes had to wait four hours for treatment. There just seems to be no understanding of how exhausting the disease is and how uncomfortable or downright painful the wait can be.

I think all doctors and nurses should be made to sit in a hair chair for hours as part of their training.

Muahahaha wrote: »

Well thats good to hear. Sad that it took a pandemic for it to be organised properly but good to hear things have changed.

That hasn’t changed everywhere!

Obvious Desperate Breakfasts

tails_naf wrote: »

The fact the xray machine was used for 2 minutes to process me, and did 2 other patients in the less than 10 mins I was there says different. They got through 3 people in less than 10 mins, with no stress or rush, just efficiency. 2 staff and one machine. I've waited longer to be checked in at reception in public hospitals, with the staff nattering to one another.

X-rays are that quick everywhere. The actual X-ray won’t take any longer in a public hospital. Why would it? I’ve been X-rayed many times in public hospitals. The scan itself takes no more than a minute or two.

Dav010

Obvious Desperate Breakfasts wrote: »

Sadly not. I went to see my oncologist in the outpatients department in July and was waiting for 3 hours in a hard chair. I complained loudly about it. If they’re not going to do anything to better organise the appointment system, they’re at least going to hear about it.
!

In order to better organise appointments, how much time would you alot to each patient, and how would you distinguish between those that might need more time and those that need less?

If you assign 30 mins to each patient, to cover delays, discussions, answer questions etc, your next appointment would probably be in 2022, if you assign 10 mins, then you have people complaining about delays when some patients take longer than others.

Obvious Desperate Breakfasts

Dav010 wrote: »

In order to better organise appointments, how much time would you alot to each patient, and how would you distinguish between those that might need more time and those that need less?

If you assign 30 mins to each patient, to cover delays, discussions, answer questions etc, your next appointment would probably be in 2022, if you assign 10 mins, then you have people complaining about delays when some patients take longer than others.

All I know is this - other countries have much better appointment systems. I know cancer patients all over the world. Some in health insurance countries, some where it’s free healthcare. Many of them have much more efficient systems than Ireland. If they can organise things well, so can Ireland. We’re not a special case. It’s lazy and defeatist to say “Oh, well, how can we possibly do it better?” Examine what the health services of other countries do. Emulate. I don’t work in this field so I can’t elaborate.

I told ya

tails_naf wrote: »

I'm at the beacon hospital for a health check and they had me do an unscheduled chest xray. I went down to the radiology department, and was registered and had the xray completed in less than 10 minutes. The radiographers themselves took about 2 minutes end to end. Results automatically sent back to the health check. This is how you save money, that one xray room can see hundreds of people a day if needs be. No way, no messing. Why can't this be the way all hospitals work?

I'm in remission and attend the Mater Hospital outpatients. I don't have insurance.

Had a fall back in January. Was due to see the consultant a few days later, told him what had happened. He said go to x-ray and come back. Went round to x-ray, was seen within 10 minutes, went back to the consultant, he had the x-ray in front of him. Had a similar experience in early 2017.

So the public hospitals can do it, at times. It's just that they're under staffed, under resourced, work practices, etc.

The population is growing and without a corresponding increase in infrastructure and staff there's always going to be long delays and waiting lists.

For €24k for the day, I'd be expecting a lot more than a speedy x-ray.

I've been to Tullamore hospital with my mum, each time she needs seeing by a nurse, then an xray and then the consultant. You check in and everything is set up for you.

We are normally there no longer than an hour and a half or so. The whole thing is very efficiently run - and they have a LOT of patients.

This hasn't been my experience in other hospitals - most notably the CUH.

eastie17

CUH A&E is a joke. Have unfortunately had to be there 3 times in the last 18 months. The problem is not staffing or facilities it’s that it is totally disorganised. No one seems to know what’s going in, they literally forget patients are their. Tests can be quiet efficient, bloods, X-rays, CTs etc the problem is it takes them an absolute age to read them and act on them.

dorothylives

https://www.boards.ie/discussion/comment/114304662#Comment_114304662

I've been to A&E 3 times last year with an elderly relative, mostly after they did damage to that person during procedures. Behind the scenes in A&E the place was filthy. I was there for 6 hours sitting on a chair with the elderly relative who collapsed after being discharged after a day procedure and had to be rushed back by ambulance. They eventually got seen by a team member that evening and got a bed at 3 am. 3 am seems to be the standard at that hospital because on all 3 occasions that's the time they got a bed. Apparently the Consultant can't admit the patient the patient has to go to A&E and be admitted that way.

I never saw a cleaner behind the scenes in the triage area, there was rubbish lying around on the floors, people dumped on trolleys and in chairs. I waited in the reception area for 2 hours after the person was brought upstairs not knowing if they were being admitted, if they were OK, what ward they were on, eventually I was given the wrong ward name. I won't name the hospital as it isn't fair to do that. But seriously, there's a massive difference between some of them. I will never forget sitting with that elderly person after their cancer diagnosis and one of the first questions the consultant asked was if they had private health insurance.

CPTM

I think once you're in the hospital it's fine. I just joined a 6 month waiting list and at the end of it I have a whopping 300 euro consultant fee. And I pay about 270 a month for health insurance.

I wish there was a more tiered approach. The issue I have could very well be sorted by a person who studied a 2 year cert with 3 years experience. Why aren't people like that available to clear out the low hanging fruit? Nope, I have to wait to see a consultant with 25 years experience.

Should be a week's wait to see someone with a 2 year cert for initial examination, who has learned how to treat the 20 or 30 most common problems in their field. If they can't, then you wait a month to go to the next level who has 5-10 years experience and knows a lot more. That failing, yeah, after 4-6 months, see the consultant.

Dyr

You don't understand, that's a commerical operation that's run in the interest of the customer

It's obviously evil in comparison to a health service thats run by the government and unions for the greater good...of the government and unions