New hospital groups report out shortly

Recommendations on the composition and number of the new hospital groups and their relationship to the university sector would be brought to the Minister for Health within the next few weeks, Prof. John Higgins, Chair of the Hospital Group Strategic Board, which was tasked last June to come up with these recommendations, told the HMI Conference. Maureen Browne reports. 

Prof.  Higgins, who is  Professor of Obstetrics & Gynaecology and Head of the College of Medicine & Health at University College, Cork, said that it was going to be a long hard slog to change our health care system.

Prof. John Higgins, Chair of the Hospital Group Strategic Board addresses the HMI Annual Conference 2012
Prof. John Higgins, Chair of the Hospital Group Strategic Board addresses the HMI Annual Conference 2012

“I think hospital groups will cause us to do additional work and I would suggest that we can only get into the work of re-configuration properly when hospital groups are announced. The groups will become the vehicle for reconfiguration by necessity. In making recommendations, our group is focused on the big picture. Our recommendations are around governance and management and many hospitals have started to discuss this between themselves and their partner universities.

“Once hospital groups are up and running, it will require an incredible amount of patience and flexibility to develop an integrated plan for any of these major hospital groups and when you get a plan you have to implement it.

“In Ireland we specialise in plans but we are poor at implementing them. Our experience in Cork and Kerry is that if you engage with staff and public representatives, the rewards are that you can start to plan radical change with substantially decreased public concern.

“You need a vast amount of consultation, if you are not to get people walking the streets and ending up protesting at Leinster House.  There is no limit to the organisations which you need to meet.  It is really hard work and we have to do it.  In our area, we now have a chart which lays out exactly and transparently the services in each of the hospitals and this is something which will be required for every area.  I think we have made good progress with implementation.

It is vital when you start the process to put your foot on the accelerator rather than the brake. If you go slowly you actually leave hospitals and staff in no man’s land.

“We have also learned two lessons regarding implementation – it is vital when you start the process to put your foot on the accelerator rather than the brake. If you go slowly you actually leave hospitals and staff in no man’s land. When you start a change which is so radical, destabilising and difficult, you must push it through quickly. When you start, gather your courage and go for it.

“Secondly, you should see planning and implementation as a continuum. If you have a lack of continuity, it makes it very difficult to keep the big picture in front of you and keep your staff engaged and involved.

“Dr. William Plested, President of the AMA, 2006/2007, said that no country could afford to provide for every citizen all the treatments that were now available.  There is nothing new about shortage of resources and the more specific context for the Irish hospital system had been given by the Minister for Health when he set out the government view on the formation of hospital groups.”

Speaking about reform programme, he said: “There really isn’t any room for easy platitudes or easy self congratulations or the self pity from which all groups suffer. We have barely started to tackle the issues. We have only scratched the surface and have much more to do than we have done.”

He said that in addition to the reconfiguration of the hospital system there were two important areas where he believed we had much more work to do than we had done –the development of clinical leadership and the change in organisational culture and attitudes.

Prof. Higgins said that the development of Clinical director role was something which he really supported. “We now have a group of clinical leaders who have been through the fire, seen the tough and difficult side of management and a group of national clinical leaders who have shaped something unique in the national clinical programmes. The second phase of the clinical director programme is now under way and we must narrow the gap between the reality and theory of the role. For years, senior clinicians in our system have been publicly lamenting that they carry responsibility without authority. The success of the Clinical Director programme will greatly affect how we engage our staff with the reformed hospital system and the entire reform programme.”

He said that we should remember that in Ireland we had many positives – we were the most successful country per head of the population in the manufacture of pharma and medical devices, which accounted for €50 billion of our exports.  The country also excelled at medical and nursing training.

“The demotivation, disempowerment and disengagement of staff within the Irish hospital system is an Achilles heel within the reform process. We fail to demonstrate faith in staff in the frontline and I welcome the presentation of the new HSE Director General, which should give hope to everybody in this room.

If we want to see real reform, we must ensure that our highly trained professional staff, clinical and non clinical, are motivated, energised and empowered. The worst thing any organisation can do is demotivate our staff.

“If we want to see real reform, we must ensure that our highly trained professional staff, clinical and non clinical, are motivated, energised and empowered. The worst thing any organisation can do is demotivate our staff.

“We have much to do regarding the culture and attitude within the hospital system. We need trust, integrity, respect and honesty and at some time they drifted out of the hospital system.  If we simply focus on new groups (and I am optimistic about that) without addressing the fundamentals we will get nowhere. The single greatest concern I have heard addressed by staff is that if this leads to a form of musical chairs then we will gain nothing. But staff are ready and enthusiastic for change.

“We have the team and the people and it’s our job to ensure that we deliver on the potential of our staff.”