The policies which health managers favour

The policies which health managers favour and the management challenges they have identified were revealed at the HSE Masterclass. Maureen Browne reports.

Dr. Sara Burke and Dr. Sarah Barry
Dr. Sara Burke and Dr. Sarah Barry

Reducing wait times in Emergency Departments, driving down the price of drugs, living within budget/austerity measures, transferring care from the hospital to the community and implementing money follows the patient were the ranked policies senior health service managers identified as important for government, according to a TCD survey.

The results of the survey, carried out by the TCD Centre for Health Policy and Management, were revealed by Dr. Sarah Barry and Dr. Sara Burke of TCD at the recent HSE Masterclass.

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The survey was based a survey of 197 senior health managers (41% response rate) last November and interviews early this year with five hospital CEOs and two ISA managers.

Drs. Burke and Barry said that managing change, integrated care, transferring care from the hospital to the community, reducing wait times in EDs and living within budget/austerity measures were the ranked policies managers identified as important for themselves.

They identified emerging management challenges as the fear that the divisional structure would further fragment the delivery of care, the need to manage this risk, the reduced resources and blocks to change, the absence of a clear or simple path for transitioning through change and the difficulties of delivering the service in the face of bureaucracy, intransigence and insecurity.

They felt there was a lack of communication, clarity and confidence in the process of reform

Comments made by managers included concern about silos and fragmentation, that the bureaucracy of the HSE and its structure had been significantly disempowering, lack of succession planning and investment in management capability.

They said managers felt positive about the development of team working, relationship building with consultants, management team and staff in general and creativity in responding to challenges by managers, frontline staff and clinical and nursing leaders.

Managers’ expectation was for continued/worsening fragmentation and capacity gaps; they felt there was a lack of communication, clarity and confidence in the process of reform and a lack of resources to implement the process of reform in the context of austerity.

Managers’ reform priorities were improving patient care/quality of care, free GP care and Universal Health Insurance, restructuring/reorganising the health system safety and quality.

There was real concern about the capacity to reform and ensure safety in the context of huge health budget cuts. One manager said “We’ve created the same environment that existed in Mid-Staffordshire, but instead of doing it on a hospital by hospital basis we’ve done it on a national basis, because we have said the only thing that really matters in discussion is budget, money and headcount – this is austerity.”

The survey was carried out as part of the Resilience Research by Prof. Steve Thomas, Dr. Sarah Barry, Dr. Sara Burke, Conor Keegan and Ella Tyrell of the TCD Centre for Health Policy & Management and Dr. Philipa Mladovsky (LSE) and Dr. Sarah Thomson (EU Observatory) http://www.medicine.tcd.ie/resilience4health/

Drs. Burke and Barry said that there had been significant and arbitrary health cuts. More had been done with less until 2012, now less was being done with less. There was a conflict between reform and austerity and quality and the ability to deliver and improve services was in severe jeopardy. The process of reform seemed to be undermining its outcome and the viability of the system was at risk.