The Conclude Consultancy

The Conclude Consultancy Limited has recently completed the first phase of a clinical reorganisation project for the 1st Department of Medicine at the Szeged University Hospital in southern Hungary.  This appointment is the first time that a UK health planning consultancy has been appointed to work in Hungary within its health system. TCC was appointed because of their unique methods for the analysis of health systems and health planning known as ‘Occupancy Analytics’ (TM). The appointment was awarded to TCC after extensive research by the the Hungarian Ministry of Health to identify internationally recognised health planning consultants who offered true innovation, rather than traditional methods of analysis, based on ‘this is the way we have always done it’ approaches. They required new ways of thinking and methods proven to deliver significant benefits.

Szeged University Hospital

The hospital is recognised as the leading institution of its kind in Hungary and has a very strong international reputation. It is currently collaborating in research with a number of UK universities such as University of Liverpool and Newcastle.  Dr Bacon, founding director of TCC leads the specialised team who are working directly with the Executive leadership team and the 1st Department of Medicine.

Why the need for the reorganisation?

Hungary has some of the worst health indicators in Europe, yet it has some of the brightest minds working in the health system. Reports from The World Health Organisation and the European Commission have both identified significant latent capacity in the health system. Simply put, the need for the reorganisation is to achieve a much needed re-alignment between clinical needs of Hungary’s citizens and the effective and efficient delivery of clinical services. The 1st Department of Medicine was selected to be the candidate department for the reorganisation, and is the sponsor of the work.

A challenge for Europe not only Hungary

Hungarian healthcare needs are, to an extent, no different to the needs of other more developed health systems elsewhere in the European Union. For example, within the next 20 years around 35% of European populations will be over the age of 75. By this age well over half of this age group will have two or more morbidities.  These pressing demands are causing significant strains in all acute care hospitals across Europe. TCC believes that in recent years these strains have become a significant concern to many health leaders because acute care facilities are ill-equipped to care for the rising numbers of patients presenting complex needs. Most notable in this respect is a primary focus on delivering healthcare through specialities, but with patients presenting comorbidity, the need is for ‘generalist specialists’ or multi-speciality services that consider the holistic needs of the patient.

TCC: Integrated Clinical Pathways

Harnessing multi-speciality skills requires carefully designed processes (Integrated Clinical Pathways) and specific skills such as co-ordination of specialist inputs and effective clinical information management along the patient care pathway. It also requires structured care plans that are designed for the specific needs of the patient, and provide the reference point for the management of the Integrated Clinical Pathway. It is in this work that the 1st Department of Internal Medicine led by TCC has been developing the major operational policies that will provide the foundation for the reorganisation and the development of the Integrated Clinical Pathways.

Ensuring that the patient receives the right care in the right place, first time is a key objective of the reorganisation and thus aligning the care system to serve the specific needs of the patient, is the primary objective. The development of an Acute Medical Assessment Unit will be one part of the clinical reorganisation. Within this multi-speciality environment the Integrated Clinical Pathways will be planned for specific patient types. Experimental pathway models using the sophisticated ‘Occupancy Analytics‘ (TM) simulations are to be developed, so that patient flows can be evaluated. It will be from this analysis that the resource needs for each pathway will be established.

Operational trial: learning from experience

A common observation of implementations of Integrated Clinical Pathways in Western Europe has been a lack of empirical evidence to substantiate the effectiveness of them. The reasons for this can only be speculated. Yet without measurement against key success criteria the benefits to both patients and staff cannot be appreciated, and the drivers for change lose impetus. To evidence the benefits of the Integrated Clinical Pathways, and to understand the operational challenges that they present to the hospital, TCC will be leading an Operational Trial for the experimental pathways using their sophisticated simulation capability to support the work. By this means it is hoped to achieve the required state of readiness for the proposed Acute Medical Assessment Unit, along with the policies and practices on which the trial will be based. Patient outcomes measures, clinical effectiveness and operational efficiency measures are all to be evaluated in the trial.