Take the stranglehold off local management
The HMI recently conducted a survey of senior managers in the health services. Preliminary results of this survey are now available and are carried in this edition of Health Manager. A full analysis will be available in the next edition.
The preliminary results make stark reading and the messages could not be clearer. The main messages include fears that the combination of further budget cuts, the ongoing moratorium and the February 2012 retirements, will seriously affect our ability to deliver services, including some of the services required by law. There are also serious concerns about the impact on the quality of service delivery and the greater challenges of the management of risk within service delivery.
The greatest challenge of all will be the maintenance of staff morale in an environment which has never been less predictable, which has never been more regulated and demanding and which more than every before is littered with visions, initiatives and strategies, without the wherewithal to implement them. For all the bravado and fine statements emanating from national level, the health service landscape is not attractive viewing and the political refuse is evident and strewn all across the system. One of the finest reports of all, the 1960s Fitzgerald Report on Acute Hospital Services, still languishes in stagnant waters.
The problems and deficiencies in our system have been as well documented as have the solutions. But let’s mention our solutions again:
1. The need for national leadership to face down local political and medical-political interests.
This will stop the fragmentation and duplication of acute hospital services within regions.
Resource-spread to appease local politics including medical politics has led to stunted service growth and inequitable service access.
2. The need for real devolved management to the regions and areas.
Mr. Cathal Magee, CEO of the HSE spoke of this at the HMI National Conference in October last and articulated his desire to see this devolution taking place. The follow-up actions are now required and the stranglehold needs to be taken off local management so that they have the authority, responsibility and accountability to manage their services locally within the resources available to them. The current command and control paradigm does not work. Real devolution means that local managers will have the freedom to organise and deploy their resources in accordance with the overall service mission and the agreed boundaries flowing from this. This will allow local empowerment, innovative thinking and service solutions to emerge which cannot happen in the current service environment.
To fully enable all of this to happen, calls for the urgent professionalisation of health service management. This will enable the required technical management and leadership competencies to be developed to allow the full realisation of the management and leadership potential that reside at various levels within the system and which will ultimately allow for the delivery of all services to the desired levels and standards which are our common aim.