Second Chance – Enable, Empower And Hold To Account

Denis Doherty casts  a cynical eye on the approach to management training of the HSE when it was established and recalls how comparisons with how the Kremlin and the Vatican acted in managing dissent were made jokingly but taken seriously by many who understandably were not prepared to put their career prospects at risk.

Denis Doherty
Denis Doherty

In 1994, the Department of Heath published a report titled “Shaping a healthier future: A strategy for effective healthcare in the 1990s”. It recognised the need to strengthen management capacity throughout the health and personal social services. A group was set up to advise how that should be done. In 1997, the Minister for Health, Michael Noonan, launched their report, “Management Development Strategy for the Health and Personal Social Services in Ireland”. He gave a commitment to implement the more than 50 recommendations it contained.

Knowledge of our health and personal social services did not seem to be important and the notion of investing for social gain ranked very far below financial considerations in the overall scheme of things.

Some of the key recommendations were:

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  • Specific and immediate action should be taken to overhaul recruitment and selection procedures to make them more open and flexible
  • Each employer should have in place good systems of job analysis, job descriptions and person specifications
  • Individual and organisational performance review systems should be introduced
  • There should be a clear relationship between personal development, management development and organisational and service objectives
  • Training budgets should be devolved to department or service level and managers should be held accountable for using these budgets in a way which demonstrably improves organisational performance
  • Health employers should introduce positive action programmes for women, ranging from recruitment and selection to flexible working arrangements and career development
  • Initiatives to support management development for professional and clinical staff should be pursued
  • Health employers should direct their spending on management at programmes and courses which have been developed in close consultation with the health services
  • Managers at various stages of their career who can demonstrate the potential to move on rapidly should be able to access individually tailored career plans and related development programmes
  • An office should be set up to begin the implementation process

The Minister set up the Office for Health Management (OHM) straight away to promote and implement management and  organisational development across the system. The Office was given a budget and the freedom to undertake the initiatives that were needed.

It quickly became apparent that the OHM approach based on developing managers and organisations to meet the needs of the communities they served, was far too radical and needed to be dealt with urgently.

It sought to do that by promoting an approach based on enabling, empowering and holding to account managers right across the system. Managers, union leaders and employers responded enthusiastically and were very supportive of the OHM. Participants in the programmes were afforded the opportunity to spend time with leading thinkers, teachers and managers from the UK, USA, Europe and Australia.

The OHM did not conduct examinations and did not award qualifications. Instead, the focus was on enabling individuals to develop personally and professionally and to contribute to realising the opportunities for improving our health and personal social services that existed then. OHM leadership programmes, master classes and courses were nearly always oversubscribed. Participants relished the benefits they derived from taking part in new ways of learning and opportunities they were able to identify to contribute to improving the services they provided. They also valued the opportunities that opened up to understand the roles of colleagues in other professions and the opportunities that existed for developing collaborative working.

The advent of the HSE was to put a stop to all that. In 2004, retail banks were seen as examples of the kind of organisations public servants should look up to. Former bankers were disproportionately represented among the newcomers engaged to install the HSE. Knowledge of our health and personal social services did not seem to be important and the notion of investing for social gain ranked very far below financial considerations in the overall scheme of things.

It quickly became apparent that the OHM approach based on developing managers and organisations to meet the needs of the communities they served, was far too radical and needed to be dealt with urgently.  Division and control was the model chosen. Some OHM staff members were assigned positions that involved moving out of the OHM office while others remained there. Not surprisingly, a ‘them and us’ divide developed that was to be experienced by many others in the early period of the HSE. By the time the HSE came into existence in Jan 2005 the OHM had effectively been stood down.

In the periods leading up to and after the coming into existence of the HSE in 2005 anyone who questioned the new conventional wisdom was branded as disloyal and suffered the consequences of that. Comparisons with how the Kremlin and the Vatican acted in managing dissent were made jokingly but taken seriously by many who understandably were not prepared to put their career prospects at risk.

During those periods, the rhetoric promised welcome change: ‘improved patient journeys,’ ‘an end to inequalities based on post-codes,’ ‘investment in primary care’ and so on. The observed behavior of the new leaders was in marked contrast to that. That early negative experience was crucial in setting the HSE on a course it has not been able to fully divert from, despite the strenuous efforts of many talented and well-meaning people. The embargo placed on attending seminars and training courses, as an austerity response measure, compounded a growing problem.

The vast majority of those employed in our health services are highly qualified and committed to the jobs they do. They come to work to make a difference to the lives of those they treat and care for. At this stage many feel beleaguered that the valuable achievements they contribute to go unnoticed while the perceived organisational failings of our health services impact them in ways they are powerless to do anything about.

In recent times we have not succeeded in differentiating between what is best done centrally and what ought to be done locally. In whatever new arrangements are introduced to address the crisis of morale within our health services and the widely held belief that our health services are not fit for purpose, it is essential that wherever health services are delivered, those delivering them need to be enabled, empowered and held to account.

The alternative would be to respond to the growing clamour for an approach based on ‘an eye for an eye and a tooth for a tooth.’ In a rather different context, John Hume dismissed a call for a similar approach by predicting it would lead to a society in which everyone would be blind and edentulous. Perish the thought!

A renewed commitment to implement the recommendations in the report of twenty years ago referred to above would be much more appealing and beneficial.