Problems Filling Senior Health Manager Posts

The lack of resources for training and development of health managers and potential health managers has resulted in an approaching crisis in the recruitment and retention of these managers. Maureen Browne reports.

Maureen Browne
Maureen Browne

Serious concern is being expressed around the country at the lack of investment in the training and development of managers to run the Irish health service, with the result that it is becoming increasingly difficult to recruit and retain managers.

“People are constantly talking about the problems of recruiting and retaining hospital consultants which are very real, but there are also huge difficulties in recruiting health managers because there is no training structure and no succession planning,” said one senior manager.

“Resources for training and development for managers and potential managers was one of the earlier areas to fall victim to the recession, no resources were provided and the Department and the HSE made no attempt to facilitate managers accessing and attending any kind of training.”

When things go wrong – which is inevitable in the current economic situation – it is the managers who have to face the media and the Public Accounts Committee.

Another agreed, saying the results were now clearly visible in two areas – the difficulty of recruiting and retaining managers and the lack of support for existing managers in managing complex and very difficult situations.

“There has been absolutely no planning in this area,” he said. “You just have to look around and see the number of top posts both in hospitals and in the community which are being filled either on an interim basis or are just vacant.

“For example, two of the Community Healthcare Organisation Chief Officers jobs are vacant and being managed by other CHOs. This is disgraceful. The CHOs are new organisations with enormous challenges and each needs the full commitment and attention of a Chief Officer. We hear all this lip service about the importance of managers and leadership, but the reality on the ground is very different. We have to ask ourselves why people are unwilling to apply for these posts. Is it that they feel they are not qualified or are that they perceive that the supports are just not there to allow them to do the job properly?”

On the hospital side, a manager said that we could consider ourselves very lucky that we have managed to get two top clinicians to take over the management of two of the big Dublin voluntary hospitals on an interim basis. “But what message does it give out that these very senior positions have not been filled on a permanent basis?

“If we are concerned about high levels of management we must plan for it. There should be investment in training and development, we need succession planning, It is crazy that we are unable to fill top jobs on a permanent basis.”

Another manager said: “The job of a health manager has become much more difficult in recent years. Managers are expected to show leadership and vision, to develop policies and strategies, to stretch inelastic budgets and then to be publicly responsible for what happens when there are no resources for specific services.

“When things go wrong – which is inevitable in the current economic situation – it is the managers who have to face the media and the Public Accounts Committee. Now I believe – and I think most managers believe – that we have to be publicly responsible for the areas which they manage, but I also believe they need training and experience on an on-going basis..

“At present people are just being set up for failure and it is not surprising that they don’t want to put themselves in these situations.”

Another manager agreed, saying she would like to see a mentoring arrangement for trainee or junior managers as part of a training structure and on-going support for senior managers. “However, there are no such structures,” she said. “People are just left to manage as best they can, which is incredibly stressful.”

Managers agree that the Minister for Health, Dr. Leo Varadkar and the Secretary General of the Department Mr. Jim Breslin have indicated support for development and training and for health managers and that this is an excellent start. However, they emphasise that a structured system needs to be introduced with a continuing professional development provision.

Several managers pointed out that health management needed to be seen as a specific profession regardless of a person’s career background. Through different backgrounds people could bring varying levels of experience and expertise to management, different qualification and competencies but that merely underlined the need to provide specific training in management itself, they said.

Managers also agree that there is an urgent need to provide specific management training for Clinical Directors, who are catapulted into the very difficult space where they are expected to provide leadership to their colleagues in areas outside clinical practice, with which they may not have expertise.