Reforming the Health Service

1. West North-West
Hospital Group
Conference 2014
“Reforming the Health Service”
Leo Kearns,
National Lead for Transformation & Change
Thursday, 9th October 2014

2. Reform - Finance
• Ireland is second only to Greece in real-term reduction of
spending on health.
Ref: Trinity Resilience Project [OECD 2009 -2011]
• The deafening silence on the funding of health and care must be
challenged (Ref: The King’s Fund, 2014)
• Funding not an inert concept – consequences and behaviours
• Vicious cycle – health the ‘basket case’ – but an impossible ‘ask’
leads to inevitable ‘failure’; and loss of focus on what is achievable
• Minister Varadker – a realistic (perhaps multi-year) budget
• Finance Operating Model – Enabling Financial Management

3. Responsibility, Authority &
Accountability
• Delivering the health service is the responsibility of
clinicians and management in public, private or voluntary
organizations & practices around the country
• With this responsibility must come accountability …. but
also the authority necessary to be held to account
• Hospital Groups and Community Healthcare Organisations
with authority are essential for real accountability
• This requires the ‘centre’ to change what it does, and how it
does it – clear roles, governance and management
structures

4. Integrated Model of Care
• Healthcare is perhaps the last ‘industry’ to address the key
challenge of ‘customer-centered service’
• If we wish to deliver high quality, patient-centred care that
utilizes resources most efficiently and effectively, we must
design and implement models of care that are conceived
and co-ordinated around the needs of the patient, and not
delivered through fragmented services that reflect legacy
institutional and professional boundaries.
• We must change from a hospital-centric (or any-centric)
model to one which is based on patient need regardless of
organizational boundaries, and which is supported and
enabled by relevant data flows.

5. Primary Acute Mental
Health
Inform & Implement Policy
Social Health &
Wellbeing
Older Person …. Clinically led, multi-disciplinary, design authority
Children …
Chronic Disease Prevention & Management …
Maternity …
Patient Flow …
Finance – funding to incentivize and support model
ICT/eHealth – systems and data flow to enable
Human Resources – culture, workforce planning, recruitment
Service
Improvement
change
management
performance
improvement
geographic,
cross
boundary,
transition to
BAU
Making Connections
Performance Indicators/Assurance – aligned measures
Design
Authority
Enablers

6. People
• The people who work in the health service are core to its
purpose
• Most still have extraordinary commitment and dedication
but many also disillusioned.
• Sadly, many are now deciding that they no longer wish to
work in the Irish Health Service.
Where there is no vision, the people
perish;
[Proverbs 29;18]

7. The People Question
• The narrative must change – support, listen, value and respect the
people who deliver the service
• We must:
• Provide a clear and consistent direction that makes sense
• Ensure that the ‘ask’, while challenging, is not impossible
• Challenge and expect high performance from all
• Support and enable with good workforce planning, succession
planning, people development, education and training
• Rebuild trust – through integrity and competence
• The Irish Health Service – become a great place to work; a
positive, values-based culture
• The people who work in the health service will lead and deliver
change

8. “it’s time for a fundamentally
new strategy”
One that focuses on
maximising value for patients:
that is achieving the best
outcomes at the lowest cost
Michael Porter & Thomas Lee, 2013

9. A health service that transforms:
From being organised around what the
system does – to being organised
around what the patient needs
From a focus on volume and cost of
services to patient outcomes achieved
From fragmented services to services
concentrated in the right locations to
deliver high-value care
Michael Porter & Thomas Lee, 2013

10. “The very essence of leadership
is that you have a vision. It’s got
to be a vision you articulate
clearly and forcefully on every
occasion. You can’t blow an
uncertain trumpet”
Theodore Hesburgh, Notre Dame

11. Portfolio of Reforms
• System Reform Group (SRG) established to provide a means to enable,
facilitate and support cross-organisational reform – Seamus Woods, Head of
Portfolio Management; Joe Ryan, Head of Innovation and Change
Management
• Organic, ad hoc, task-driven, siloed approach not acceptable – must take a
prioritised, planned, structured, programmatic approach

12. Portfolio of Reforms
• System Reform Group (SRG) established to provide a means to enable,
facilitate and support cross-organisational reform – Seamus Woods, Head of
Portfolio Management; Joe Ryan, Head of Innovation and Change
Management
• Organic, ad hoc, task-driven, siloed approach not acceptable – must take a
prioritised, planned, structured, programmatic approach
Some Reform Programmes:
• Finance Operating Model
• Ambulance Service
• Embedding Quality & Safety
• VfM Disability Services
• Older Persons Services
• Implementation of Healthy
Ireland
• Workforce Planning ……..

13. Portfolio of Reforms
• System Reform Group (SRG) established to provide a means to enable,
facilitate and support cross-organisational reform – Seamus Woods, Head of
Portfolio Management; Joe Ryan, Head of Innovation and Change
Management
• Organic, ad hoc, task-driven, siloed approach not acceptable – must take a
prioritised, planned, structured, programmatic approach
For Each Programme
• Vision and Objectives?
• Plan, Timelines, Deliverables?
• Communication Strategy?
• Resource Strategy?
• Interdependencies?
• Expertise required?
• Governance & Management?
Some Reform Programmes:
• Finance Operating Model
• Ambulance Service
• Embedding Quality & Safety
• VfM Disability Services
• Older Persons Services
• Implementation of Healthy
Ireland
• Workforce Planning ……..

14. Portfolio of Reforms
• System Reform Group (SRG) established to provide a means to enable,
facilitate and support cross-organisational reform – Seamus Woods, Head of
Portfolio Management; Joe Ryan, Head of Innovation and Change
Management
• Organic, ad hoc, task-driven, siloed approach not acceptable – must take a
prioritised, planned, structured, programmatic approach
For Each Programme
• Vision and Objectives?
• Plan, Timelines, Deliverables?
• Communication Strategy?
• Resource Strategy?
• Interdependencies?
• Expertise required?
• Governance & Management?
Some Reform Programmes:
• Finance Operating Model
• Ambulance Service
• Embedding Quality & Safety
• VfM Disability Services
• Older Persons Services
• Implementation of Healthy
Ireland
• Workforce Planning ……..
HSE Leadership Reform Steering Group – Health Reform Board in DOH

15. Establishment of Hospital Groups
Moving responsibility, authority and accountability closer
to the patient.
• Appointment of Group CEOs – key leadership step
• Development of Strategic Plans (Guidelines from SAG imminent)
• Governance & Management Arrangements
• Clinical Directorates defined across Groups
• Prioritised Operational Plans; business redesign
• Developmental Programme; workforce planning; retention; culture
• Communications & Stakeholder Engagement
• Interface with Community Healthcare Organisations
• Interface with other Groups
• Essential to work with Integrated Care Programmes
• National Childrens Hospital – Scoping of Integration Project
underway

16. Establishment of Community
Healthcare Organisations
Moving responsibility, authority and accountability closer
to the patient.
• Launched October 8
• 9 Community Healthcare Organisations
• Based around 90 local networks of c50,000 population
• Close integration with Primary Care, Social, Mental Health, Health &
Wellbeing
• Strong clinical leadership
• Implementation Programme Established – Mr Pat Healy Sponsor
• Cross-organisational Steering Group/Working Group
• Project scoping and planning underway
• Essential to link with work of Hospital Groups & ICP
• Major change programme

17. Establishment of Integrated
Care Model
Clinically-led, multi-disciplinary, cross-organisational design
authority for models of care
• Building on National Clinical Programmes, Dr Aine Carroll Sponsor
• Formal relationship with Medical, Nursing and HSCP Professional Bodies
• Group Programme Lead with joint role with Programmes and Care Group
Division:
• Dr Colm Henry (Acute); Dr Margo Wrigley (Mental Health); Dr Orla O’Reilly (Health &
Wellbeing); GP Lead and Social Care Lead recruitment underway
• 5 Integrated Care Programmes Identified
• Older Person
• Chronic Disease Prevention and Management
• Children
• Patient Flow
• Maternal
• Clinical Programmes being consolidated where appropriate and aligned with
Integrated Care Programmes
• Operating Model – Links with MFTP and ICT being established

18. ICT/eHealth
Patient empowerment; support integrated clinical models
of care; enable joined-up planning, evaluation and policy
• eHealth Strategy published
• Individual Health Identifier Legislation
• Appointment of Chief Information Officer for Health Service
imminent
• Development of ICT Strategy underway
• Industry Engagement Process underway
• Transition of ICT to newly formed Office of CIO
• Redefined Operating Model for ICT
• Balance of local empowerment and national strategy
• New funding model for ICT

19. Challenges to Reform
 Do we have a vision that engages people, that is
clear to them, is consistent and persistent?
 Creating space to change
 Our ability to plan, manage and deliver complex
change
 Difficulty in taking a co-ordinated approach
 Lack of specific expertise within health service
 Communication challenge
 Need to rebuild trust
 National policy and strategy – local ownership and
delivery
 Business as usual v change

20. “You’ve got to think about big things
while you’re doing small things, so that
all the small things go in the right
direction”
Alvin Toffler

21. “Unlike even the very best
management process, leadership has
as its primary function the
production of change.
“Without leadership, purposeful
change of any magnitude is almost
impossible”
John Kotter, 1992

22. As a LEADER ……
….. if not me, then who?