Managers fear they will be unable to deliver

A HMI survey has revealed that senior health managers are concerned that in the wake of the February staff departures they may be unable to deliver specific services, including some statutory services, writes Maureen Browne.

Senior health managers are concerned that, while all services will be cut this year, the uneven distribution of staff who will leave the health services at the end of next month, combined with their inability to move resources to where they are required, may result in an inability to deliver specific services required by patients or clients, some of which are required by law.

surveyThey also believe that continuing to provide services with the reduced resources available in certain areas will compromise the quality of services provided.  Across the board, managers say the reduced resources will impact on the quality and risk of services.

These were among the main results to emerge from a survey of 132 senior managers, carried out by the Health Management Institute of Ireland, over the last four weeks.

Across the board, managers say the reduced resources will impact on the quality and risk of services

Eighty per cent of those surveyed were either senior or middle managers and 20 per cent were front line managers.

In addition to the impact on front-line services, managers were also concerned about the ability of support services including IT, HR and Health Care Records to meet the needs of front-line staff. They fear that this will result in a gradual erosion of the ability of front-line staff to carry out their work.

The survey also revealed that resources have now become so stretched, that managers say their ability to devote time and resources to transforming services is limited.

The concerns of those who responded focused on their ability to sustain services in 2012 and to operate effectively as service managers.  The results of the survey may have been influenced by the fact that it is too early to appreciate the positive impact of some of the transformational programmes and changes which have been introduced.

The survey sought managers’ views on a wide range of issues including the moratorium, budget/service cutbacks and somewhat ‘hidden costs’ such as the effect of increments and VAT on resource availability.

It posed three substantive questions:

  • How will the changes affect health service delivery?
  • What are the resultant challenges they face as managers?
  • What actions should be taken?

Managers felt the main challenges they faced in the coming year were staff morale, the lack of appropriately qualified professional staff and the ability to deliver the required standard of care. In turn, these challenges gave rise to the more fundamental challenge of deciding which services to cut.  Managers believed these challenges stemmed as much from the abrupt transition expected on March 1, as from the changes and cutbacks themselves.

Some senior managers advocated changes to the Croke Park Agreement and felt key stakeholders should provide the necessary supports for this

They see a major problem in the fact that they are expected to achieve significant changes in a short time frame without being given the authority to take action.  They are also concerned that they do not have the time to commit to the change process because their on-going involvement in clinical work is accentuated by staff shortages.

They are worried about an on-going deterioration which may arise out of increased stress on their staff and on the danger of burnout for some staff before any changes have a positive effect.

Managers said there were a number of areas in which they felt action should be taken, with leadership the common ingredient linking these areas.

More and stronger communications was mentioned frequently in the responses.

Managers felt it was vital to prioritise services and to focus resources in the prioritised areas.  This approach will require top management to be clear in their communications regarding priorities. It would also require stakeholder acceptance that it is not always possible to continue to deliver services in the future as in the past.

There was agreement on the need to recruit front-line staff in order to continue to provide services in prioritised areas.  Such recruitment needs to be strategically thought out as some managers suggested that replacement of frontline staff could be transferred from acute to community where it maybe more appropriately located.

Some senior managers advocated changes to the Croke Park Agreement and felt key stakeholders should provide the necessary supports for this.

Middle and senior managers in the survey emphasised the need for systems thinking to drive the change.  Recommendations ranged from the introduction of lean management methodologies, Six Sigma and the rapid roll-out of Information and Communication Technology (ICT) as a means of enabling a quantum change to service delivery within the resource constraints available.

There was also a highly significant pool of specific initiatives proposed.  These include staff flexibility and increased autonomy for managers. They show the value of staff involvement in meeting the challenges faced and in moving towards improved service performance in the future.

The HMI will publish a full analysis of the results of the survey.