1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
Foundations for Governance;
Designing the structure and preparing for Clinical Directorates in a Model 4 Hospital
Liz Moran MSc in Healthcare Management
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Abstract
Background: This project centres on defining the structures and preparing our organisation (UH) for the implementation of Clinical Directorates. Clinical Directorates are managed clinical units led by a Clinical Director, who is accountable for the provision of safe quality patient care within allocated resources. Following self-assessment against a number of national reports, UH identified weaknesses in its Corporate and Clinical Governance. This prompted the Executive Management Board of the hospital to implement a Clinical Directorate structure. Methodology: The new structure was designed by a stakeholder representative group who discussed, debated and made decisions based on data provided by the author. This data was gathered from research, sites of best practice and stakeholder corporate memories. Each decision by the representative group was reflected as a deliverable on the project plan. A substantial consultation process also took place with influential stakeholders. The HSE Change Model helped guide the change process. Evaluation: A significant organisational change such as this can be challenging particularly in a complex environment such as an acute hospital. The CIPP evaluation model was used to guide the evaluation. The aims and objectives were achieved. A new Organogram has been designed and all clinical services are mapped to one of four Clinical Directorates. Organisational Impact: This is a political process so robust leadership and the capacity to build and sustain relationships is critical. The agreed structures, a leadership development programme, and the project plan will ensure UH is ready to move into the implementation phase of the Clinical Directorate project.

2. Foundations for Governance;
Designing the structure and preparing for Clinical Directorates in a Model 4 Hospital
Liz Moran MSc in Healthcare Management
Introduction & Background
Methodology
Evaluation
University Hospital (UH) is one of two Model 4 Hospitals in the Hospital Group. Self Assessment against the HIQA Safer Better HealthCare standards1 and the Limerick Report2 identified weaknesses in the Corporate and Clinical Governance. The EMB decided to introduce Clinical Directorates to strengthen the governance and align the hospital for the move to the Group Directorate structure in the near future. UH needs to strengthen its position as a model 4 hospital to continue to serve the people of the region.
Figure 1: Force Field AnalysisNeed for strategy
Lack of clinical leadership
The HSE change model was used to guide the project.
Initiation:
EMB decision to introduce Clinical Directorates.
EMB appoint student as Project Manager.
EMB seek volunteers from EMB to be on representative group for decision making and to support Project Manager.
Planning:
Representative Group (CDSG) of stakeholders established.
Liaison with National Clinical Directorate Programme
Development of SWOT and Stakeholder Analysis
Data gathered through consultation with stakeholders, literature review, visiting sites of best practice
Development of a project Risk register
Implementation:
CDSG debate and decision-making on directorate options
Decisions communicated out to wider hospital
Ongoing engagement with stakeholders
Identification of leaders
Mainstreaming:
Agreed Organogram circulated
Allocations of Clinical Staff completed
Clinical Directorate Project Team appointed
Clinical Director posts advertised
A new hospital structure is defined and the organisation is ready for Directorates.
A new Organogram was developed.
All Clinical Services/Staff are assigned a Directorate.
Terms of Reference for the new EMB has been agreed.
A Gantt Chart for implementation is complete.
Four Clinical Director posts were advertised
Figure 3: New UH Organogram
Hospital Group
Shared Services
Medical CD
Peri-op CD
Women & Child CD
Diagnostic CD
EMB
Organisational Impact
Figure 2: HSE Change Model 3
Development and maintenance of relationships is critical to the Clinical Directorates.
Resilient leadership is pivotal.
Access to and ability to interpret data is crucial; as data will be the common language.
A comprehensive leadership development programme for the teams will ensure a strong foundation for the four Directorates.
Managing the politics has been critical.
Aims & Objectives
Aim: To design a structure and prepare for Clinical Directorates in University Hospital by 30th April 2015.
Objectives: Design and agree an organogram to reflect the new structures by March 30th 2015.
Assign all clinical staff to a Clinical Directorate by 30th March 2015.
Develop and secure sign off on Terms of Reference for new EMB by 15th April 2015.
Complete a Gantt Chart for the implementation phase of the Project by the 30th April 2015
Advertise Clinical Director Posts by 30th April 2015
References
1. HIQA. National Standards for Safer Better Healthcare. Dublin: HIQA, 2012.
2.HIQA. Report of the review of the governance arrangements as reflected in the safety, quality and standards of services at UL Hospitals. Dublin: HIQA, 2013.
3. HSE. Improving Our Services, A Users’ Guide to Managing Change in the Health Service Executive. Dublin: HSE, 2008.
4. Stufflebeam D, The CIPP Model for Program Evaluation. In: Madaus G, Stufflebeam D, editors. Evaluation Models. Dordrecht: Kluiver-Nijoff;