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Stephen Bolsin: how I turned around healthcare services Stephen Bolsin: how I turned around healthcare services
(2 months later)
Long before David Cameron coined the phrase the "friends and family test", the cardiac surgeons and myself, as director of anaesthesia at Geelong hospital, near Melbourne, Australia, designed and implemented a safe and reliable cardiac surgery service. We measured key outcomes to confirm our performance. Our axiom was that "the service had to be good enough for us, or our relatives".Long before David Cameron coined the phrase the "friends and family test", the cardiac surgeons and myself, as director of anaesthesia at Geelong hospital, near Melbourne, Australia, designed and implemented a safe and reliable cardiac surgery service. We measured key outcomes to confirm our performance. Our axiom was that "the service had to be good enough for us, or our relatives".
I left Bristol Royal infirmary in 1996 after blowing the whistle on the needless deaths of 170 children following cardiac surgery. I joined a small department in Melbourne that had no acute or chronic pain service, elective surgery patients were admitted the night before their operation and I had to help guide the start of an adult cardiac surgery service.I left Bristol Royal infirmary in 1996 after blowing the whistle on the needless deaths of 170 children following cardiac surgery. I joined a small department in Melbourne that had no acute or chronic pain service, elective surgery patients were admitted the night before their operation and I had to help guide the start of an adult cardiac surgery service.
We progressed within five years to a mortality rate in the lowest quarter of all centres in the state of Victoria. We measured our wound infection rates and discovered that attention to detail had produced the lowest wound infection rate in the world. We published our performance in 2000. We compared our complication rates to other centres and confirmed the lowest re-exploration rates and the third lowest renal failure rate in the world. We published these results in 2004 and 2007, respectively. The cardiac surgery service that we had designed had developed such a focus on providing quality for its patients that it had become excellent.We progressed within five years to a mortality rate in the lowest quarter of all centres in the state of Victoria. We measured our wound infection rates and discovered that attention to detail had produced the lowest wound infection rate in the world. We published our performance in 2000. We compared our complication rates to other centres and confirmed the lowest re-exploration rates and the third lowest renal failure rate in the world. We published these results in 2004 and 2007, respectively. The cardiac surgery service that we had designed had developed such a focus on providing quality for its patients that it had become excellent.
So, when I needed coronary artery surgery and was recommended a private hospital in Melbourne, I insisted my surgery should be in Geelong where I knew my chances of survival and avoiding complications were as high as anywhere in the world. There were no complications.So, when I needed coronary artery surgery and was recommended a private hospital in Melbourne, I insisted my surgery should be in Geelong where I knew my chances of survival and avoiding complications were as high as anywhere in the world. There were no complications.
Some NHS health managers and professionals have said the pursuit of excellence in healthcare is extremely difficult and may be impossible to achieve. I could not disagree more profoundly with such ill-informed comments. I believe that excellent services cost less than bad ones because they do not have to pay for treating avoidable complications. Excellent services can do more work because they have fewer patients with avoidable complications occupying beds, reducing throughput and leading to cancellations.Some NHS health managers and professionals have said the pursuit of excellence in healthcare is extremely difficult and may be impossible to achieve. I could not disagree more profoundly with such ill-informed comments. I believe that excellent services cost less than bad ones because they do not have to pay for treating avoidable complications. Excellent services can do more work because they have fewer patients with avoidable complications occupying beds, reducing throughput and leading to cancellations.
I introduced a service that reviewed every patient prior to elective surgery and arranged admission on the day of operation. This meant one night in hospital was shaved off every elective surgery patient. This saved the hospital A$4m (£2.5m) in the first year, and reduced cancellation rates (close to zero) and the unnecessary testing of patients. The CEO was able to close one surgical ward without reducing the surgical throughput of the hospital. When we examined our activity in 2000 we had a 98% "day of surgery" admission rate, which was the best in the world, again.I introduced a service that reviewed every patient prior to elective surgery and arranged admission on the day of operation. This meant one night in hospital was shaved off every elective surgery patient. This saved the hospital A$4m (£2.5m) in the first year, and reduced cancellation rates (close to zero) and the unnecessary testing of patients. The CEO was able to close one surgical ward without reducing the surgical throughput of the hospital. When we examined our activity in 2000 we had a 98% "day of surgery" admission rate, which was the best in the world, again.
Excellence with savings is not impossible – it should be expected, and if it is not being achieved, remove or retrain the "non-experts". How does this experience apply to the NHS? I believe that every healthcare employee wants to provide the highest possible standard of care to their patients, particularly when serious outcomes must be avoided. Knowing this, the responsibility of the NHS manager must be to provide the necessary resources, including information, care plans, facilities and funding to help the frontline carers achieve the best possible outcomes. The mystery for me is how NHS managers have become so divorced from such simple commonsense for so long as to allow so many patients to die.Excellence with savings is not impossible – it should be expected, and if it is not being achieved, remove or retrain the "non-experts". How does this experience apply to the NHS? I believe that every healthcare employee wants to provide the highest possible standard of care to their patients, particularly when serious outcomes must be avoided. Knowing this, the responsibility of the NHS manager must be to provide the necessary resources, including information, care plans, facilities and funding to help the frontline carers achieve the best possible outcomes. The mystery for me is how NHS managers have become so divorced from such simple commonsense for so long as to allow so many patients to die.
• Stephen Bolsin was anaesthetist at Bristol Royal infirmary (1988-1996). He is an adjunct professor and specialist anaesthetist at Geelong hospital near Melbourne, Australia• Stephen Bolsin was anaesthetist at Bristol Royal infirmary (1988-1996). He is an adjunct professor and specialist anaesthetist at Geelong hospital near Melbourne, Australia
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