Speaker 0 | 00:11.088
Welcome to Building the Hospital of the Future, a podcast from Bon Secours Health System. Over the course of this series, we're taking you behind the scenes of a purpose-built hospital designed from the ground up in Limerick. From the first sketch on paper to the first patient through the door, we'll meet the people behind it all. Because the future of medicine isn't just technology or treatment. It's how those things come together to make people feel safe, feel seen, and truly cared for. Today, we're joined by Dr. Siobhan Grimes, consultant, anesthetist, and clinical director of Bon Secours Hospital, Limerick, to talk about what care looks like when it's designed around patients and backed by world-class teams. Siobhan, welcome to the podcast.

Speaker 1 | 00:57.877
Thank you.

Speaker 0 | 01:00.340
Siobhan, I remember getting a tour of the New Limerick Hospital and at that stage it was just brick and mortar, mostly. But I was lucky enough to do the tour alongside you. And you had an incredible understanding and knowledge of where exactly we were in the brick and mortar building. You knew every nook and cranny, and you were so excited and enthusiastic. It was so fantastic to absorb that on the day. Now, over your shoulder, we can see the new Limerick Hospital almost built. How does it feel?

Speaker 1 | 01:36.553
Oh, it's hugely exciting. It's just fantastic to be associated with a phenomenal medical resource like this hospital. It's been a great experience to watch it develop from the first few rough drawings into this building that we see outside the window here. There have been many unsuccessful attempts to bring a private hospital into this region, and, you know, the proof is in the pudding. This building is fantastic and is going to deliver fantastic care. I have a personal interest in that I was born in Limerick. My mother's from Clare, my dad's from Kerry, and I have family who live in Tipperary. So in this region, I have roots. And it's very, very important to my extended family and all of my compatriots in those counties. That we have a state-of-the-art facility that we can use for our care.

Speaker 0 | 02:33.883
That's so nice to hear. And it seems like across the project team, that's the feeling. Would you say the whole project team is invested in the community and the counties that it serves?

Speaker 1 | 02:44.817
Hugely. I know you've been talking to Jason Kenny and we have to forgive him for being from Cork. But outside of that, even he has started to become a little bit limerick-ised or, you know, certainly, you know more north of Kanturk, I think. But yeah, the team is a team. It started off as a very small team. Steve Jobs said a number of years ago, and he was quoted in a book that I read, that if you want to have something done well, you get a small team of very invested people, and they will deliver. And that's what's happened here. The team has expanded. When it needed to expand, to incorporate people who had were of like mind, as you say, who did have a vision, who did have the energy, the passion, the capacity, And that's why it's grown into the team that it is today. We're so invested in this. And you'll find that. Some of the team members who are on the design team, they're now looking at being partners with us in the hospital going forwards, looking after the building. So, you know, that just shows you they're not in it for a short time. We're all in it to deliver something that is going to stand out there for the next couple of hundred years.

Speaker 0 | 04:04.276
So, Siobhan, what kind of lens are you viewing it at the moment? Obviously there's a huge clinical challenge, but there's obviously so much excitement and opportunity. Are you seeing lots of difficulties getting through the challenges?

Speaker 1 | 04:18.385
No, because it developed really organically. So where did we start? We started off with an innate, like I said, my family can tell you, or anybody who's lived in these counties, that we needed this kind of facility. So we all thought we knew that. So how were we going to figure out what we needed? We went and we spoke to more families. We went and we spoke to GPs. We spoke to patients. We did some digging with EY to find out where were patients going to when they left Limerick? What were they going for? What hospitals were they going to? How far do they have to go for it? What was it they were going for? Could we do that here? And that's, that pile of work. Took us probably the first six or nine months of the design team's life to just do that. Is there a reason to do this? Couple that with the Bon Secours, who you have to take your hat off to them. They came and bought Barrington's from the great Paul O'Byrne. They did a couple of things that were very important when they did that. Number one, they kept an awful lot of Barrington's staff. And so that Barrington's ethos still lives on. That's really important. And the second thing they did was they threw down a gauntlet to Jason Kenny. And they said, sweat this building, make it look like it's about to burst and we'll give you a new one. And there you go. That's what he did. It has become very busy. We have a very personalized, safe service. That is being, I think it's gone up something like fourfold, what the numbers were in the year that. The Bonds bought Barrington's first. We've introduced orthopaedics, we've introduced overnight patients, we've expanded the endoscopy, we've expanded the oral Maxo-fac, urology has expanded hugely. And it became very obvious that, yes, there was a need. Yes, people were coming. And yes, the place was unfortunately too small.

Speaker 0 | 06:24.114
And it sounds like it was a great opportunity to refine your clinical vision. Of what the new hospital needed, because you were able to have almost a pilot program with Barrington's. Would you say it really supported your case as you moved towards the planning stages for the new Limerick Hospital?

Speaker 1 | 06:40.653
Absolutely. It dictated it. It did. So once we had that list of wishes, or needs more in the area, we then looked to see what we could provide. So this hospital will complement the other medical facilities that are in this region. There's no point saying we want to create a mini-UHL. UHL does what it does really well, but it is under pressure. So there are lots of things that we can do, that we can do hand-in-hand with them. We will be another phase or another layer of medical care in this region and we will concentrate on building high-level care for a specific range of procedures. These are using pathways that keep patients in the region. Diagnostics and treatment in the same place, is possible, and it's possible to do extremely well when you focus on the number that you can do. So we took that list of needs for the region and we married that with who's already here, doing fantastic work, who want to work with us, and what facilities do they need to deliver that need. And so we will not have absolutely everything in this hospital. We will have an awful lot more across the board in terms of the variety that we will, of patients we look after and the variety of services we offer. That's going to be an awful lot broader than we offer at the moment. It won't be absolutely everything, but what it will be, will be state of the art for every single one of those things.

Speaker 0 | 08:36.726
Can we get into details about like what specialities we actually chose to prioritise there? Obviously, you said it was really an organic piece coming out of the new hospital and talking to the community and the GPs like, Well, which kind of specialities in specific are we looking at prioritizing at the new hospital? 

Speaker 1 | 09:00.534
So I would, you know, you could say no particular order, because I could be accused of favoritism. But the one that jumps out for me personally is cardiology. We, in 2016 or 17, my dad had an MI and we put him in the car and drove him to Dublin, and he had his stent put in in Dublin. Alongside that, then, if you have cardiology patients in, you know, in my world, that makes you on the medical side. Now, no patient is a medical patient or a surgical patient. All patients are, you know, a mixture of both. But today, you might be a medical patient. Tomorrow, you might be a surgical patient. In our terms, cardiology is on the medical side. And so it needs the backup of other medical specialities, may be that endocrinologists or care of the elderly, physicians or renal physicians, or gastroenterology physicians, whatever. So we are now building something that we've never had before, which is a medical department. And that medical department will run through this hospital. And so cardiology, medicine, two massive things that we haven't done before. And so, as you can well imagine, we have, you know, been utilizing everybody in the region who has the expertise to get us up there on that learning curve.

Speaker 0 | 10:16.626
I think the people of the Midwest are really going to see the benefit of having this new additional access to cardiology and medicine services. And, of course, with these new services comes new words and acronyms. And a new one for a lot of people, I suppose, is going to be HAU. What is a HAU?

Speaker 1 | 10:36.535
A hospital access unit is a HAU. So the journey for the patient coming from the GP is that the GP refers them to the hospital access Unit. They get a slot. So that could be an urgent slot for today. It could be an urgent slot for tomorrow. Or it could be this is something that's grumbling on. This man will need to come in for a few days for diagnostic tests. He needs a few days to get things together and he'll be in on Friday. So it will be organized in that way. And when the patient comes into the hospital access unit, they will be seen by an ED consultant. So all of our consultants, and I should say this, are on the specialist register for whatever their speciality is. They all are very high level and we are very fussy about who works with us. And the ED consultant, case in point, will see you in HAU and with his team, they will do the diagnostics that are necessary. Now, if you need something that brings you into the hospital, your care will then be transferred to a relevant physician in the hospital. If you need something that is available outside of the hospital, you will be referred for that. So whatever you need, the triage will be done. The diagnostics will be done as much as possible. And then a plan will be made for you, and you'll be on your way to the next point in the journey.

Speaker 0 | 12:06.496
Fantastic. So I think we understand HAUs a little bit better now. We've talked a little bit about cardiology. What other services are coming to the New Limerick Hospital?

Speaker 1 | 12:15.341
One that is very unusual to a private hospital is vascular surgery. And vascular surgery is a very big speciality. So at one end you have varicose veins and at the other end you have aortic aneurysms and major, major surgery. And we are extremely lucky to have two very highly thought of, very accomplished vascular surgeons who work together, who have both come full-time private to the Bons in the last year and a half. And who are going to develop their practice into the new hospital, so at the moment they're doing the smaller acuity stuff in Barrington's because that's what we can do. And in the new hospital, they will be introducing more complex procedures. So, um, that's, that's a, that's a huge departure for us. Uh, we also will have breast surgery, and again, that's something that needs a lot of setup. It needs a lot of support and it needed an awful lot of thinking and talking and planning to get it right. So that we will be very proud to have a mammography service through the hospital. And then we will expand other things that we do already. So urology, we will expand. The lower GI, we will expand quite a bit in terms of the acuity or how much we can do. Again, a little bit like with vascular in Barrington's, we do the smaller procedures. We'll be moving to doing bigger procedures when we're in the new hospital. When we started, or when the Bonds bought Barrington's first, the first thing to be introduced was an orthopedic service and an overnight service for hip and knee replacements, particularly now we do foot and ankle also. And in the new hospital, we'll be doing upper limb. But the knee and ankle, knee and hip service, it's extremely busy and it is under a lot of pressure. And we will be doing an awful lot more of that.

Speaker 0 | 14:25.658
Fantastic. So in episode one, Jason was telling us a little bit about ophthalmology, and he talks about it with such excitement, about the patient pathway. Can you talk to us about the clinical side of how that's going to work in the New Limerick Hospital?

Speaker 1 | 14:42.470
One of the biggest drawbacks in Barrington's has been the journey from the front door, the new front door, or even the old front door, to the Ophthalmology department. So for the people who come in there, they're often elderly, they obviously have sight issues and they have to make their way through the whole place. From that kernel in Barrington's, has developed a fantastic situation where we have the portal of care for ophthalmology is from beginning to end. It is right inside the front door. I'm sure Jason told you that. So you just literally have to get to the front door, into the first portal. And from there, you have access to your consultant. You have access to the pre-op assessment for if you do need surgery. You have all of the diagnostics, you have laser, you have biometrics, where, you know, if you're having surgery done, you have measurements made of your eyes. All of that gets done there. If you are somebody who has an ongoing chronic illness where you need regular injections, we have the injection room there. And so you'll be coming to the same place to have your injections done. If you need to have your cataract done. You go further up the corridor, the theatres are on the right hand side, you have your surgery done, We have everything from the state-of-the-art ophthalmology microscope to the anaesthetic machines to the chairs that you are admitted on. That turn into a table so you can have your surgery, and then they fold back into a chair so you can be brought out again. It's all state-of-the-art. And then you go out into the recovery room, you have dedicated eye nurses looking after you. We have two spaces where we can deal with more complex cases. And then at the end, you go out the front door again and away you go home, so it's that is, yeah. That's something that, as I say, evolved from somewhere where there was an absolute need that we could see. And it will really be a fantastic facility. 

Speaker 0 | 16:58.094
Um, before we pressed Record this morning, you were telling me about the clinical equipment and how important it is that we purchased and sourced world-class clinical equipment when we were moving to the New Limerick Hospital. Tell me a little bit about what we have.

Speaker 1 | 17:12.085
We didn't just go out and buy a new microscope. We went out and we bought the best one, the one that is future-proof, the one that can do that extra and bring our consultants to an extra level. What did we do for vascular? Well... We redesigned a whole theatre. Once we realised that we were going to be able to do this, we redesigned the theatre, put in a control room, put in a permanent CT scanner in the room. This enables our consultants who can use this technology. So that's our vascular. In the general theatre and urology, I was going to say, there's a plethora, well, there's a few robots so we're going to have robotic assisted surgery again, it's not a robot sitting in the corner who's telling us what to do. This is robotic technology that is the next generation it is, sometimes it's a small robot, like in neurology, they have a robot that is the size of, you know, your laptop nearly, um. But it is making more scientific decisions with the surgeon, it's allowing him to make more scientific decisions. And then I suppose the big one really is radiology. From the diagnostics point of view, we have, as I say, an association with Alliance Medical. It's a joint venture, but, you know, three CT scanners, two MRIs, the first PET scanner on the Western seaboard, everything digitally enabled, digitally enabling. The multidisciplinary meetings that will happen in the multidisciplinary room that is built on the ground floor. All of these things, I mean, that room is an AV room, it's it's just a room where the surgeons can interact with the histopathologist, can interact with the radiologist. Can, you know, make plans and decisions in a timely fashion using that digitalization? So, and then the last space, I suppose in the clinical world, would be the cardiology suite, which is state of the art.

Speaker 0 | 19:29.163
All of that sounds fantastic. I suppose from a patient's standpoint, they're going to be interested in the correlations between all that fantastic technology and what their patient outcome is going to be. Tell us a little bit about that.

Speaker 1 | 19:44.831
It is enabling technology, and that's the buzz. It's to enable things. It's to allow us to do what we do well. And patients tell us we look after them well. And certainly when I'm in the pre-assessment clinic, when people come in, the first thing I say is... I'm your anaesthetist. I'm going to look after you. That's my job. You know, I'm a human to look after you. I might use a whole load of technology to do it, but the job is to mind you and to make sure that you're OK.

Speaker 0 | 20:14.535
And how are the consultants feeling about the change?

Speaker 1 | 20:18.176
They are invested. They are people who are at the top of their game. They can stand on their own two feet and within a department. Or sometimes there's only one of them in their department. They can hold their own with every other consultant. We benchmark what our consultants do across a number of things, be it the orthopedic register or be it the endoscopy register. We can point to what they do and say it is the best in the country. It is as good as you will find in any other hospital. And they do that because it's reputation. Their reputation is important. Our reputation is important. And they have invested in the build. They've invested in the design. They've given their opinions about what is and what isn't possible to do. They have listened to what the patients actually need. They have adjusted or expanded what they plan to do based on that. They have engaged with the electronic health record. They have engaged with the purchasing of technology. They've engaged with the purchasing of machinery. They have worked very closely with the hospital management team, Jason and the rest of us to answer the questions that we can't answer. And, you know, there is great excitement amongst those consultants also. They're looking forward to working in somewhere like this. And for their patients, it's going to be so much easier for them to do what they do well. Of course, there's enthusiasm, so.

Speaker 0 | 21:54.938
And when we talk about consultants, we often hear this additional term, which is the clinical service hub. It got introduced by Jason in the first episode. And we understand that. We have the beautiful glass facade of the new Limerick hospital, and behind it, there is this clinical service hub. Tell me a little bit about it and how it integrates with the consultants.

Speaker 1 | 22:31.748
Yes, the clinical services hub is a five-story building, and it's 10,000 square feet on each floor. So it's a massive building and it will provide diagnostics and outpatient facilities. There are two floors that are dedicated to consultant suites. And there are two floors. The ground floor is radiology diagnostics. So that's where the two CT scanners, the PET scanner, the ultrasound, the plain x-ray for outpatients will be. And on the floor in between, there's going to be speciality diagnostics. So vascular diagnostics, mammography diagnostics, endocrinology diagnostics. There'll be pre-op assessment. So that building. Is going to be as busy, if not busier, than the hospital. And as I mentioned earlier, the electronic health record will start in that building and will follow the patient, if the patient needs a procedure, into the hospital building. And so the surgeons and the physicians will do their rooms in that building, and then they will follow up with their patients as they admit them into the hospital.

Speaker 0 | 23:50.778
Well, it's fantastic. It sounds like the patient has been put first and the clinical service hub is going to be such an important factor. And especially since it's so close to the actual main hospital, we also know other factors are important for the patient, such as recovery. We've heard this new term in terms of biophilic design to support the patient. Can you tell me a little bit about that and other recovery elements in the new hospital?

Speaker 1 | 24:17.560
So, biophilic design in a hospital, it focuses on incorporating natural elements. So that's whether it's plants, natural light, water, views of nature or organic building materials. So this is in your architecture, in your interior spaces, but also in your exterior spaces. So in our hospital, as you said, there's a load of glass in the front. It's very obvious there's an awful lot of light. In the building, which is very important. And we also have a developing healing garden. So that's a garden that literally the plants and the way it's planted and the way that you can move through that garden, it's all designed to help with your healing process. And that might be the healing process for staff when they've had a hard day, as much as for patients. We also have access to a rooftop garden for our inpatients, our surgical and medical inpatients. In my mind, that always was something that normalises the world for somebody who's having surgery. You get stuck in a room for a week and then you go back out and you blink in the sunlight. If you can have a walk, you know, after you've had your hip done, instead of just walking down the corridor, if you can walk outside. In amongst, you know, fresh air, in amongst the plants, it's going to, it's going to actually help remind you that what you're having your surgery for is to get yourself back out there, into the world. And so, um, the, the rooftop, um, garden is something that's kind of close to my heart. But outside of that, even the biophilic colours, so the colours that are on the walls, the colours that are on the floors, the colours that are on the background in the bedrooms, we all had our ideas of what we thought those should be. And then the interior designers came along and said, Have you ever heard of biophilic? Well, sort of. But there are actually colours that have been proven to help with your healing process. We know that there are some colours that are what we would call emetogenic, they make you sick. There are some that are very relaxing. And they've actually done research onto what colours will help you. When you are going through surgery, recovery, or if you're just lying in bed because, you know, you have a chest infection. They have research that tells you what helps. And so these are the colours that you will see when you go through our hospital. And it is complemented by the Navarra ash, which is the wood panelling that you also see flow through the hospital. The original wood panelling that we had was a dark wood panel. And I suppose we were looking for the private hospital feel. So we all thought, oh yeah, you know, dark wood would be lovely. And we had it made up in a mock bedroom, and we all walked into it and thought, it's a bit austere. And particularly when you have the gentle colours of the biophilic stuff, which wasn't right. So we went back to the drawing board and the Navarra ash was introduced. It's a much gentler, softer wood. And that's an example of the biophilic interior design that's going to be in this hospital.

Speaker 0 | 27:58.480
One of the new features of the hospital is this move away from traditional departments that people probably know and understand to this new idea of portals of care. How is the introduction of portals of care going to improve patient experience?

Speaker 1 | 28:15.371
What we are trying to do is we are trying to provide what the patient needs as the patient needs it. So, like with the Ophthalmology department, the portal of care provides the care that that patient needs. It's not that you have to come and interact with us on our level, on our terms. It's that you need something from us, and so we're going to give you this portal of care that will do everything for you. It'll bring you in and it will get you in the right place. It'll show you how we're going to process you through your procedure. It's going to get you through the procedure safely. And then it's going to allow you to take a little bit of a breather afterwards, gather yourself together, make whatever arrangements you need, and then, you know, get back out and, you know, go on with what you need to do in your day. So the day procedure unit is what it says. You're coming in for something and you will be in for part of the day, but you're not staying overnight. So you don't have to be going up onto a ward, you don't have to be mingling with patients who are having bigger operations, you don't have to be delayed by the fact that you're having something small done, somebody in front of you is having something big done, and you have to wait for them to have that done. That's not what's happening. We're trying to tailor it to what you need. You need to come in for an infusion, so you come into a room that has a comfortable chair to sit on. You don't come into a room that today is used for endoscopy and tomorrow is used for infusions. And you come to the same place every time, you see the same people every time, and it is designed around you. If you come in at eight o'clock in the morning and your infusion is finished at 11. And that's when you want your cup of tea, that's when you get your cup of tea, not the cup of tea comes at eight o'clock love, you missed it, terribly sorry. So that, you know, that's the day procedure unit. The hospital access unit we talked about already. It is designed, your GP sends you in and you're looked after by a consultant there. What you need afterwards, you have a clear plan of where you're going and what's happening next. So, again, it's designed around you. And if you need diagnostics, you don't have to go away and have your diagnostics done in another hospital and send us back the CD-ROM. It is done for you from there. You can go over and back, get whatever diagnostics you need on that day. And then, as I say, once you have the plan, you go ahead after that. Upstairs, when you start to go into the portals for endoscopy, again, in Barrington's, everything's done on the same floor. So there were people having to wait in places that, you know, they're waiting beside somebody who's having something big done. But I'm having something small done, but I still have to change my clothes. Because the person having the big thing needs to be in a sterile area. But I'm only having, like, a small little, you know, thing taken off my forehead. And but I still have to go through all of that stuff. I'm going to be here for hours because I'm in the same. That's changed. So when you're having a minor op, you come in, you have your minor op, you're only there for the length of time it needs to get it done and out you go. If you're staying in, if you're going up to the portals upstairs. If it is endoscopy, it's endoscopy. If it is a day procedure, you're in the day procedure. And then if you're going to be admitted into a ward, you're into the rooms. They're all single rooms. They all have beautiful, you know, vistas, views. You will be in there and you will be catered for from your point of view. You know, what it is that you need. It's not that you're driven in there to use the system, and the system doesn't care what you need or what you want. It's the opposite. And so the portals for upstairs into day surgery or inpatient care, they're very different and they have a very different vibe to them. And from the time that you're going in, you're expected to know, you know, your departure time should be this. So, you know, whoever's collecting you, you don't have to be second guessing things. The system will tell you how long you'll be there and if there's a reason that you need to stay there longer. You'll be facilitated to do that, too but, you know, it's kind of giving people a little bit more clarity. And then the access to those units is a little bit easier, also from the outside. So the, you know, we're using again technology to interact with patients beforehand. To make sure that they have the education, to make sure that they have the instructions, to make sure that everything is done so that you're not lost when you come through the door. You're just looking for that portal, it's another step on that journey. You've already understood what's going on, has gone on beforehand and how you've got to this point. And then you'll know where you're going afterwards.

Speaker 0 | 33:12.316
And Siobhan, I understand the health system's on a great digital transformation journey at the moment, which really sounds like it's going to align nicely with this new hospital being the hospital of the future. Tell us a little bit more about it.

Speaker 1 | 33:27.683
We have engaged with a global partner for the introduction of an electronic health record. That record will start with the patient in the outpatients, and it will end after the patient goes out to the GP. And everything in between will be captured, and not only captured, but accessible to everybody who needs to use that information. Whether that's, you know, the person in the diagnostic part of the cycle, or the person in the procedure part of the cycle, that's important. So the electronic health record, it's a multi-million euro project. It has been rolled out across the five hospitals. We as a hospital are engaging with it even more, maybe, than the others. For instance, we are using the ambulatory part of that module, which is the part that's in outpatients. And we think that's very important, that we can take things from the beginning all the way through to the end. So the electronic health record buzzing away there, in the background. You should not be aware of it when you come in. I should be aware of it because I'm using it. I should know how to use it really well. So we need lots of training. But it's something that's enabling the way I do my care for you. It's not doing it for me, but it is making me do it at a better level.

Speaker 0 | 34:48.594
Siobhan, It's so exciting to hear about the incredible clinical vision for the new hospital. I think all the patients, staff, consultants and GPs are going to feel empowered listening to you talk about the advanced technologies and new services coming to the people of the Midwest. Siobhan Thanks so much for your time.

Speaker 1 | 35:07.536
Thanks, JP. Thank you.

Speaker 0 | 35:09.558
That was Dr. Siobhan Grimes, clinical director of the New Limerick Hospital. Stay with us over the next few episodes as we explore the key stakeholders and the key decisions that are going to make and build this new hospital of the future.