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many agents pursuing objectives that can be at variance with overall
system goals. Effective management will not be achieved through
a `command and control' approach, but will require leadership,
which mixes incentives and inhibitors to achieve results. It is vital to
ensure effective control, capacity and capability at all levels with clear
Looking at 2013, he noted that the three per cent reduction in the
public sector budget was part of an overall 22 per cent reduction since
2008. He warned: "Further reductions are likely to render higher
potential for dysfunctionality, unless we achieve significant structural
change. "
He concluded: "We can take reassurance that the changes experienced
in the Irish system are not novel and there is learning available to us
from the experiences of other countries. What we need are tailor-
made solutions and action plans at national and local level. There is
a core requirement in relation to a Quality Regulator - this function
must be operational not soon, but right now. Finally, although we
have to remain aware of fiscal limits, our focus must be a design for
improved performance, rather than perceived inefficiency removal."
Professor Pierce Grace, presented an early stage assessment of service
delivery in the new networks from his perspective as Chief Clinical
Director, UL Hospitals, Limerick. The UL Hospitals Group covers
counties Limerick and Clare, as well as North Tipperary, he said.
"Our Group, although the smallest network comparatively, serves a
population of 387,000."
Professor Grace highlighted a series of achievements by the Group
over the past few years, including:
unifying the Department of Radiology;
introducing new simplified medical rosters; and,
moving all Model 2 hospitals to selected take.
One of the most effective innovations implemented by the group
has been the `Huddle': "This is a daily, thirty-minute conference call
across the organisation sharing key updates and information and has
proven to be extremely effective in flagging potential problems in
advance and integrating cross-group activities."
In assessing performance under the new network structure, he
identifies a number of positives. "A good governance system is now in
place and an effective directorate structure has become embedded in
our organisation. The Huddle gives a daily profile of directorates, sites
and risk. As a group, we have 7,472 more inpatients and 11,094 more
outpatients. Our index procedures show improved outcomes and
patient flow is better with trolley counts falling."
He also identified aspects of service delivery, which could be better.
"The lack of a Model 3 Hospital is a constraint, as is the fact that the
Group's Maternity Hospital is stand-alone. From an organisational
perspective we don't have optimum efficiency with, for example,
a separate governance structure for St John's Hospital. We are also
finding it challenging to fill Model 2 hospital beds with appropriate
patients. More generally, we are also facing difficulties in relation both
to the European Working Time Directive and recruitment."
In his overview of the academic partnership perspective, Professor
Kelly suggested that perhaps the most important achievement of
the Higgins report is the acceptance of the Academic Health Centre
model, as the optimal model for the delivery of healthcare, by the
Department of Health and the HSE. "With its three-part mission
of education, research and service, this model has proven itself,
throughout the developed world, as being effective in improving
patient care and providing an effective stimulus for economic
growth." RCSI considers the successful establishment of RCSI
Academic Hospitals Group as a major priority and focus. "We
cover North Dublin and the North-East with a catchment area that
combines superb transport links, the M1, rail, the country's principal
airport and three commercial ports. Add to this the link with Belfast
and a very large land bank available for development and it is clear,
we face challenges in terms of demand for our services. However, it
is equally clear that we have tremendous opportunities for links with
industry and an available educated workforce."
Every country in the developed world is facing the same crisis in
healthcare ­ a combination of unsustainable costs and relentless
demand for more services, with ageing populations and advances
in healthcare, Professor Kelly noted. Professor Kelly cited the work
of Michael Porter, the leading authority on company strategy and
the competitiveness of nations and regions on the most significant
barriers to effective and meaningful change in healthcare delivery,
which include:
the organisation of clinicians around their specialty, rather than
around the patient's condition;
hospitals tend to be widely dispersed for historical reasons and,
therefore, try to offer the full spectrum of cover;
reimbursement systems are flawed, with some services being very
lucrative and others reimbursed below actual costs; and,
widely acknowledged problems caused by a lack of a uniform IT
Professor Kelly observed: "Because these barriers to change reinforce
each other, incremental fixes do not work. Real change requires a
true strategic transformation. We are all well aware of the challenges
ahead. To help inform our strategic planning, it's important that
we are given early guidance on the criteria under which we will be
He added: "The launch of the hospital networks is a once-in-a-
generation opportunity for the acute hospital sector. It is timely that
we now focus on the biggest health issue of our generation­ how to
bring affordable, safe and high quality healthcare to the Irish people."
The panel of speakers on Hospital Networks (l-r): Professor John R.
Higgins, Professor of Obstetrics & Gynaecology and Head of College
of Medicine & Health, University College Cork; Mr Ian Carter, National
Director, Acute Hospitals, HSE; Professor Pierce Grace, Chief Clinical
Director, UL Hospitals, Limerick; and Professor Cathal Kelly, CEO/
Registrar, RCSI.
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