Taking Our TEAM from Transactional to Collaborative

Working together as an integrated team, HSCPs (Health and Social Care Professionals) can achieve immediate meaningful change for patients by collaboratively influencing and shaping improvements in our services.

As the Senior Speech and Language Therapist in the Acute Stroke Team, I was acutely aware of the life changing impact early intervention from HSCPs has on patient outcomes. HSCP frustration due to the often lengthy process from admission to referral was the driver for my  team’s improvement project – which was progressed using the Rapid Improvement Event (RIE) methodology.   

Some background information

We set about turning around referral and assessment times in real-time, taking advantage of the supports offered through the Ireland East Hospital Group (IEHG) and Mullingar hospital management. The HSCP team provided unique insight into the inter-disciplinary interaction of a patient’s journey from admission to discharge, identifying value versus non-value steps throughout admission. We identified the causes of delays in the referral process to HSCP, which were leading to delays in assessing/treating our patients.  Inefficient/segregated non-prioritised referrals were the root cause.

What we did

A new HSCP integrated referral and screening tool was developed incorporating speech and language therapy, dietetics, physiotherapy and occupational therapy. When we implemented the tool, we continually sought staff feedback at 30, 60 and 90 day phase points allowing us to refine the pipeline further.

Bringing together a wide range of expertise enabled us to design a tool that reflected the specific  criteria that were important across disciplines. Coming together also facilitated communication about the new pathway across all wards and hospital teams.

The team I led in this project encountered various challenges along the way but their positive attitude and commitment of the team I led helped overcome challenges as we worked together to achieve a single referral system, shared prioritisation criteria and merged priority ratings and waiting times for patients.

The project was rolled out in two phases initially with a pilot site ward and subsequently to all wards across the acute hospital. To support the change in practice, we developed a communications package and an education programme.

In order to ensure that the project would be fully embedded in the hospital, we implemented a sustainability model assessment to identify the strengths and weaknesses of our plan increasing the likelihood for long-term adoption and sustainability. 


The project has brought multiple disciplines together in a patient centric approach. It was supported by the wider hospital workforce and management and significantly reduced waste and transformed care while maintaining and improving quality of practice. Patients were seen according to priority and patients received care in a timely fashion. This reduced the patient’s hospital stay and increased wellbeing.  

The specific measured outcomes at the 90 day stage of the project included

Delivering high quality patient care is always the goal for a high performing HSCP team. Our patients now receive a more responsive, tailored approach and most importantly, receive services at the time they most need it by delivering better outcomes through safer, faster, better care.

My reflections

This approach has been readily adopted by sites across the IEHG as a model of good practice which speaks volumes as healthcare systems do not adopt practices that do not provide true benefits to patient outcomes. Our project also won the award for Best Innovation and Collaboration at the IEHG Adopting Lean for Healthcare Transformation Summit, Farmleigh House, Phoenix Park Dublin 2017.

I take great pride in the real successes of this project, the improved patient care and the positive feedback from the medical teams.

I would like to thank my MDT colleagues Grainne Flanagan, Dietician Manager, Miriam Dolan Senior Physiotherapist, Paula Sheridan Occupational Therapist, Cathal McKeon Multi Task Attendant, Lorraine Daly Admin, Suzanne Waldron CNM2, Mairead Carey Occupational Therapy Manager and Dr. Senan Glynn, Consultant. I also want to thank Anne Horgan and Anne Marie McKeon from the IEHG Service Improvement Team and Kay Slevin and Shona Schneemann from Regional Hospital Mullingar Management.

This Blog was written by Caroline Colgan, Senior Speech and Language Therapist Acute Stroke Team, Regional Hospital Mullingar.

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