A Time for Brave Decisions
Those of us who attended the HMI/RCPI Leadership Briefing on 5th March last in RCPI can only have been impressed by what was an inspiring and riveting afternoon. The briefing was conducted by Mr. Michael Dowling (President and Chief Executive) and Dr. Lawrence Smith (Executive Vice President and Physician in Chief) who preside over a healthcare network of 16 hospitals and over 270 ambulatory care centres in greater New York. We gazed in wonderment.
The scale of the operation, their achievements from the get go and their capacity to sustain the enterprise as a high performing system were clearly based on two foundation pillars: Leadership and Autonomy. Leadership of the system at all levels is actively underwritten by the early identification and streaming of selected staff into developmental pathways, by the active and visible affirmation of the systems values into all its processes and by fostering and reinforcing a culture of openness, transparency and accountability. Hand in hand with this leadership is an autonomy that ensures, for the most of metropolitan New York, that the health care delivery remains value and mission focussed at all times and that any barriers preventing this are resolutely and promptly dealt with. Yes, it may be described as a highly personalised leadership style with an autonomy bordering on the rampant. But the lessons nonetheless are salutary and valid when measured against the sizeable shift required to bring our systems close to this plane.
Now that we are finally (?) on the cusp of a cabinet decision regarding the reshaping of our acute hospitals into groups and ultimately into independent Trusts, it is time for an honest debate and statement of what the leaders of such Trusts require to be in place so that they can deliver to, and beyond, the desired level. Many good things have been achieved over the past 8 years of the HSE’s existence and this would not have happened without the (initial) requirement to centralise and control. The biggest test now is for control to be ceded back to the new hospital groups so that a new confidence is locally built across the service support functions and that service development and delivery can flourish within new geographic confines. Has the centre the capacity and the will to do this ?
The absence of real autonomy for the leaders of Hospital Groups will be a lifetime opportunity lost. It will condemn the new groups/trusts to a stunted growth and allow partisan agendas to emerge bringing about little real success and much mediocrity. We will again be left to gaze in wonderment at what others can achieve. We all deserve better.