•A PESTLE and SWOT analysis

identified key external and internal

drivers

•Leadership and senior

management support essential

•Stakeholder analysis identified key

stakeholders on the basis of power,

influence and interest

•A shared vision was agreed

through consolidation with

stakeholders

•Detailed plan of activities to

achieve the vision

•Communication strategy

developed. Communication was

essential to maintain momentum

•Showing staff monthly figures-

change was taking place

•Ensuring day surgery is ‘the way

we do business around here’

Increasing Day Surgery Rates For Inguinal Hernia Repair

Author: 9102528

MSc in Leadership and Management Development

Institute of Leadership, Royal College of Surgeons in Ireland

Introduction & Background Evaluation

The results highlighted that with

effective communication and a

committed team change can happen

but changing culture in ‘the way we

do things’ takes time

Aims & Objectives

Organisational Impact

Conclusion

•Reduced in-patient waiting list-

patients should wait no longer than

6 months for admission2

•More efficient bed usage- day care

activity has increased by 43% for

Jan-March 2011

•Reduced hospital costs- average

day case cost for inguinal hernia

repair is €1,700 compared to €3,100

for in-patient care4

•Reduction in hospital acquired

infection

•More efficient use of theatre

The HSE change model guided the

implementation of a change initiative

to increase day surgery rates for

inguinal hernia repair and we need

to ensure day surgery becomes the

norm. Referring all patients for pre-

operative assessment and changing

practices to identify patients will lead

to greater success.

Change Process

References 1.Smith,I., Cooke,T., Jackson, I. & Fitzpatrick, R.(2006). Rising

to the challenges of achieving day surgery targets.

Anaesthesia, 61, 1191-1199.

2. PA-Consulting. (2007). Acute Hospital Bed Capacity Review:

A preferred health system in Ireland to 2020. Dublin.

Healthcare Commission.

3. Health Service Executive. (2008). Improving our Services: A

user’s guide to managing change in the health service

executive. Dublin. Health Service Executive.

4.Health Service Executive. (2009). HealthStat: supporting high

performance in the Irish health system. Dublin. Health Service

Executive.

Figure 1: HSE Change Model 3 Figure 1: Monthly Key

Performance Indicators (KPI)4

There are numerous advantages to

day surgery yet figures vary

enormously1. The HSE has set a

target of 75% for the internationally

recognised basket of 24 procedures

suitable for day surgery2 In an

academic teaching hospital 100%

cataract surgery and 97%

arthroscopy surgery are performed

as day cases, which is in stark

contrast to inguinal hernia repair

surgery which was as low as 14%.

The focus of this change initiative

was to increase day surgery rates

for inguinal hernia repair by

implementing a number of strategies

guided by the HSE change model of

initiation, planning, implementation

and mainstreaming3

Aim: To increase day surgery figures

for inguinal hernia repair.

Objectives:

•To change the practice in

identifying patients suitable for day

surgery in Ambulatory Day Care

Centre (ADCC) clinic and/or pre-

assessment clinic.

•To review current in-patient records

to identify reasons for admission

0%

5%

10%

15%

20%

25%

30%

35%

Oct Nov Dec Jan Feb

Month

% D

ay C

ases

Plan

•Meetings with Consultants

•Amendments to waiting

list booking form to identify

day surgery patients

•Pre-assessment clinic-

refer all surgical patients

to the service