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Reforming the HSE

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When plans for the the HSE were formally announced by Ministers Martin and McCreevy in June 2003 they proposed to rationalise agencies, manage the health service as a national entity, reform the hospitals sector, improve policy development and oversight, ensure quality and effectiveness of care, devolve responsibility, and improve the planning and delivery of service.

Five years later, the Fitzgerald report on issues arising from the Review of Breast Radiology Services at the Midland Hospital profiled a dysfunctional management structure and concluded that "fundamentally the problems arose from systemic weaknesses of governance, management, and communication for dealing with critical situations ...".

It cannot be claimed that there were no external warnings about structural problems in the HSE. In a review of senior posts after the HSE's establishment in 2005, the Review Body on Higher Remuneration found "that there was a lack of clarity at this stage about the future content of jobs. We are aware also of proposed alterations to the current structure which may result in changes in elements of the roles being exercised at present with implications for the extent of management responsibilities and other factors which are central to any evaluation of the jobs".

When revisiting the matter in its September 2007 report, the Review Body stated that "there is still some lack of clarity about the precise direction and reporting relationships of some of the jobs we examined and this made it difficult to evaluate them. We concluded that there is still an element of evolution about some of the management posts. At this stage in the development of the HSE we would have expected to find a clearer and more stable organisation structure. We would urge the management of the HSE to address this issue as a matter of urgency".

With the Minister, Department and HSE all wringing their hands with concern and simultaneously washing their hands of real responsibility and appearing to lack the will or authority to make long overdue root and branch changes, it is easy to see why the HSE is having problems.

Aside from rereading the Prospectus and Brennan reports which set out roadmaps for the HSE, they would do well to also check out Machiavelli on implementing change and Jack Welsh on delayering and lean management.

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This page contains a single entry by Brian published on March 17, 2008 12:39 PM.

From Trams to Chaos was the previous entry in this blog.

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