A Vision of Success

Queensland Eye Hospital

We would be hard pressed, I think, to find any reader out there who actually likes the idea of eye surgery. Such a sensitive organ is often able o be improved with minor corrective care, but even then it is a big step to entrust the eye, of all things, to the knife. But Queensland Eye Hospital’s Chief Executive Mark Grey is at pains to stress that the experience can be made as worry-free as possible.

“If you provide a centre of excellence, which includes provision of the right instruments, equipment and facilities, and programmes for nursing and support staff, you will have a facility that surgeons will wish to come to and that builds a sense of excellence,” Mark explains. That, in turn, drives profitability. If you do not run it as a highly structured business with a good understanding of costs and controlling them, it will also not be profitable of course, but, “the key point is that surgeons will only come to a facility if it is exceptionally well set up.”

The critical point, says Mark, and what makes Queensland Eye Hospital (QEH) “the leading ophthalmic hospital in Australia,” is the attention that has been paid to recruitment and training, “especially of our nursing staff, giving support and expertise to enable the surgeons to do their job without obstacles, quickly – and the quicker they work, the more jobs can be done in a session, so that increases profitability. All these things are interwoven.”

An essential element of QEH’s success has been its access to the best, leading edge equipment from the time of its launch. Ever since, the hospital has continued to invest in itself, working closely with suppliers to stay abreast of the latest technologies and ensuring that the latest techniques are available to surgeons. Offering surgeons a wide range of choice in terms of the equipment they prefer to use “leads to better patient outcomes,” explains Mark, “which is the total focus of this hospital.”

The position of the Queensland Eye Hospital as a leading institution was not achieved overnight. Some 15 years ago QEH was formed, like many other day hospitals around the country, out of a sense of frustration among surgeons that they had to share major private hospitals with other specialists – orthopaedic, say, or neurosurgery – which were deemed to be more critical in terms of early operative care, and in some cases also seen as more profitable, leaving eye experts with little in the way of leverage to get their own requirements prioritised. Eye surgery is micro-surgery – using very fine instrumentation, often with the use of microscopy – in contrast to many other medical disciplines, some of which require much bigger, stronger machinery – and it simply does not benefit from the way traditional hospital theatres are set up. Promises to rectify this situation had not come to fruition, so in 1997 a group of surgeons took the matter into their own hands to create the specialist facility that later became QEH, which is owned by the surgeons themselves rather than a body corporate – an important distinction, says Mark, because they have a vested interest in making sure the facilities are optimal.

Fiona O’Sullivan, QEH’s Marketing and Training Coordinator, explains that although most of the work done at QEH is elective (usually in the sense that it is not time-critical), it is not cosmetic and the hospital does not promote itself to the general public. Rather, GPs and optometrists refer cases to the ophthalmologists and the facility offers a complete contrast to the one-stop laser correction facilities on many high streets. The hospital is designed for serious disease and trauma microsurgery on the eyes – including relatively well-known complaints such as cataracts – and around 85 per cent of patients are funded by health insurance.

QEH is estimated to carry out in the region of 60 per cent (some 6,000 procedures per year) of all eye-related procedures in the Brisbane area, and Mark says that while profit is healthy, it is not the primary objective. Revenues enable the facility to carry out a higher than usual proportion of operations on glaucoma and paediatric surgery (such as juvenile cataracts and correction of strabismus) which are less well remunerated by the authorities, as well as advanced techniques such as corneal grafts which can restore sight. “This is a place of comprehensive ophthalmology, which encourages all forms of eye surgery specialities. Otherwise, patients would have to go into the public sector” for such treatments and would probably have to wait a relatively long time. At QEH, “we take our position very seriously in ensuring all ophthalmologists of whatever persuasion are welcome here.” If this were a corporatised business model, it would likely cut out most of these advanced procedures and concentrate on the simpler and more profitable ones instead.

Fiona explains that QEH has taken decisive steps to try to overcome the challenge of finding staff – particularly nurses, who are in short supply around Queensland. The most important aspect is training programmes, for novice nurses who have recently finished their degrees and for graduate nurses alike. “We are growing our own nurses and we have a really high retention rate.”

QEH’s somewhat unusual business model demands equally unusual growth patterns. Rather than going out and building a dozen more similar hospitals around Australia, Mark says, “which would have been a tempting proposition,” the team instead created a body called the Independent Ophthalmic Network, designed to support and assist existing ophthalmic day hospitals across the country, and the practices where surgeons do their consulting, to better understand the business of ophthalmology as opposed to the science – how to build a better structure in a hospital and attract more and better surgeons. “This tells people of an independent frame of mind that they can also get business, financial and supplier management advice without having to be part of a corporatised entity.”

QEH is not a research facility but some of the surgeons who practice there are on the leading edge of eye-repair technology. One of its shareholding surgeons, Dr Andrew Apel, began working with intra-ocular contact lenses about four years ago and is currently working on partial-thickness corneal grafts (which reduce the risk of infection compared to grafts of the full cornea). Another, Professor Lawrence Hirst, has restricted his clinical practice exclusively to the surgery of pterygium (non-malignant, slow-growing proliferations of conjunctival connective tissue in the eye and a disease of which Queensland has the highest prevalence in the world due not least to the influence of sun and UV rays) using what he calls P.E.R.F.E.C.T. for PTERYGIUM, a technique he pioneered and which has the world’s lowest recurrence rate at 1 in 1000 and the world’s best cosmetic appearance, with most eyes after this form of surgery indistinguishable from a normal eye. He has established the world’s first dedicated pterygium centre supervised by a corneal trained surgeon and performing the procedure.

The latest equipment, says Mark, is in most cases a vital factor in maintaining a competitive edge, but not always. “Over the last two years we have upgraded all our microscopes and phago machines (used in cataract surgery). In terms of what we have, it’s the world’s best.” The latest technique for cataract surgery is called LACS (laser-assisted, but not to be confused with cosmetic laser surgery); “it’s very early days yet and we are waiting to see some of the clinical data. No one has it in Brisbane at this stage. Sometimes in this market it is better to be a very fast second-mover,” rather than the pioneer who has to resolve any teething troubles.

Ultimately, QEH’s secret, Mark says, is the way it is structured as a cooperative model based on the comprehensive approach to the procedures it carries out, as opposed to the more conventional “top-down” approach which tends to dictate the structure, the type of equipment and the type of procedures the facility will carry out. The training programmes, too, have benefited under this structure, whereby student nurses can be assessed during their clinical placement before being accepted to the graduate training scheme. There is even a scheme for optometrists to do part of their compulsory Continuous Professional Improvement programme (40 hours per year) at QEH, which offers seminars run by the surgeons to help them get to grips with new technology as well as getting to know the hospital and its facilities.

In short, it is easy to see (pardon the pun) why Mark, his staff and the shareholder surgeons believe QEH has the model for optimum patient outcomes.

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

December 19, 2018, 9:24 AM AEDT