Experiences of developed management in the Cardiovascular Service at Royal Adelaide Hospital

Devolved management structures are on trial at Royal Adelaide Hospital with assistance from the Clinical Devolution Project. The trial is to assess the suitability of devolved management structures to support clinical decision making, and to evaluate financial management reporting systems and information support systems. A nurse at Assistant Director of Nursing level and a doctor head each of the three trial Clinical services. Both have equal responsibilities and delegations of authority for day to day operations utilising an allocated budget. The impact of devolution of responsibility to clinical units is considerable. Such reorganisation presents opportunities and difficulties. Nurse/doctor collaboration is essential to manage high patient throughout effectively and efficiently as well as to prepare for the impact of casemix and output based funding. Clinical department size, budget allocation, roles and organisational infrastructure affect the success or failure of devolved management structures, even if a service works within an allocated budget and achieves high patent throughput and decreasing length of patient stay.