People and Organisation Development – Time to Reflect and Act?

Denis Doherty
Denis Doherty

The Health Management Institute (HMI) organised a highly successful ‘Congress of the European Association of Hospital Managers’ in Dublin in 2006. Dr. Greg Laskow, from the Centre for Creative Leadership (CCL) in Brussels summarised the key messages of speakers from Ireland, Europe and the USA. His first point was-

 ‘If health care leaders do not establish clear direction, ultimately patients will, via the court system,’ writes Denis Doherty.

It seems we are still learning, via the court system! In February 2023, it was reported that “a 25 year old woman with cerebral palsy who sued over the circumstances of her birth has settled her action against the Health Services Executive (HSE) for €35.2 million”.

We know that the court system can deal only with pain, suffering and loss, award compensation and recommend the steps that should be taken to avoid repeat occurrences. It then falls to those in a position to implement change to do so in concerted and effective ways. Our record, in that regard, hardly bears scrutiny.

Other key points made by Dr. Laskow were:

  • Patients are increasingly seeking care across boundaries: more mobility across boundaries
  • This is no longer the era of ‘trust me’; we are now in the era of ‘show me’
  • We can no longer manage as managers alone
  • We, as leaders, need to collapse the boundaries between hospitals and communities
  • We have increasing populations requiring health care
  • We have increasing chronic disease patterns
  • We need to develop strategies, as leaders, so as to lead through the “pain” of the “painful three years” of organisational transformation
  • During change in organisations, it is more about changing hearts and minds than structures and processes.

Dr Laskow went on to remind the health services leaders present of their responsibility to develop the next generation of leaders. He saw the challenge as being considerable. He predicted that healthcare was set to become more complex and more global. He also predicted that it would not be easy, in the face of competition from other sectors, to assemble a sufficient talent pool to satisfy future needs and that it would be even more difficult to retain developing leaders as they continue to demonstrate their ability. He was particularly critical of leaders who advocate a particular approach and practice another.

Many of the considerations identified back then seem valid still.

To what extent have new considerations emerged in the meantime and to what extent is our healthcare system equipped to deal with emerging challenges?

Our health services are about to face reorganisation of delivery systems and an era of universal entitlement, free at the point of delivery, if Sláintecare is actually implemented as recommended. It seems to me remarkable that there is little political or general discussion on the costs, service implications, and disruption to providers, users and employees that will be involved. I have not heard any discussion on the projected benefits from all this proposed change.

The approach taken in the later years of the last century and the early years of this one has much to commend it. Reform of the then health boards system was long overdue and consideration of what reforms would best meet our future needs took far too long also.

In 1994, the Minister for Health published ‘Shaping a healthier future. A strategy for effective healthcare in the 1990s.’ It identified as a weakness – ‘The organisation and management structures, which are now in place for almost a quarter of a century, need to be updated to provide for more effective decision making and accountability”. In response to that recommendation, the Department of Health established a committee chaired by Dr. Maureen Dixon, a distinguished healthcare expert based in London. The role of the Committee was to advise the Department on how best to overcome the weakness identified in the strategy. The committee researched best practice internationally in healthcare management and consulted widely.

One of the recommendations of the ‘Dixon Report’ was that there needed to be special attention given to the ongoing development of managers and management systems across all of our health services. That recommendation was accepted; the required funding was provided in 1997 and the Office for Health Management (OHM) was set up, The Department was most supportive, provided the necessary funding and played an important supportive role that enabled the OHM to work closely with service delivery systems, across all areas of healthcare in developing its work programmes. The role of the OHM was broadly enabling; it was ‘to facilitate management development for the health services in Ireland.’ The OHM developed strong links with people development and health management organisations in the UK, Brussels and the USA. Ireland benefited from the valuable inputs from visiting academics and healthcare management experts from Britain and the USA.

It has always seemed to me, and I know to many others, that the OHM performed a valuable role in meeting the development needs of our staff and our healthcare providers. Investment was made in areas where needs specific to our healthcare system had been identified. Early on, for example, the OHM created a development programme for young managers (under 35 years of age) many of whom went on to fill senior management positions in our healthcare system. Many of that group of young managers, remain leaders in healthcare here. Those for whom the service we provided was intended saw the fact that the office was independent of vested interests in the people training and development areas as an advantage. Smaller provider organisations and their staffs were particularly pleased to have full access to the OHM training and development initiatives.

Even if the OHM is viewed as ‘of its time,’ there exists a case for a current version of that type of organisation. OHM was created as a result of investment in research consultation on how the people management and organisation development needs of the National Health Strategy would be best met. For reasons never explained, the OHM didn’t survive the health services transition to the HSE.

The Health Management Institute was always supportive of the OHM; was always generous with advice from managers who knew what the development needs of managers, systems and resources were. In my view, now is an appropriate time to seek the advice of the Institute in developing people and systems strategies.

Note: The considerable volume of published material of the OHM is available at