elacsaplau
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I want Joe Schmidt
New boss for the HSE
- Thread starter elacsaplau
- Start date
I wasn't born in 1971 and there's no need to refer to AAM members as posers!
I turned down the HSE job myself.
Although the plan I developed to improve the HSE was accepted as being just what was needed, there was no political willingness to give me the authority to implement it.
No new legislation to support e-records.
No support to break the logjam on salary linkages. I couldn't give nurses and other difficult-to-recruit staff pay raises without offering the same to all other grades.
No support to implement revised job descriptions without union agreement.
No support to streamline appointments by penalising people who miss their time slots.
No political cover in the event of a scandal breaking in the media, wether the events occurred on my watch or previously.
Although the money was derisory for an organisation with 100,000 staff, that was not the main issue.
Lots of responsibility, with almost no power. Set up to fail.
Although the plan I developed to improve the HSE was accepted as being just what was needed, there was no political willingness to give me the authority to implement it.
No new legislation to support e-records.
No support to break the logjam on salary linkages. I couldn't give nurses and other difficult-to-recruit staff pay raises without offering the same to all other grades.
No support to implement revised job descriptions without union agreement.
No support to streamline appointments by penalising people who miss their time slots.
No political cover in the event of a scandal breaking in the media, wether the events occurred on my watch or previously.
Although the money was derisory for an organisation with 100,000 staff, that was not the main issue.
Lots of responsibility, with almost no power. Set up to fail.
Interestingly, I was interviewed for the job too and stated that my main activity would be to design the organisation based on an open systems model. Organisation design, OD, at this level begins with repurposing the organisation based on the views / feedback from the organisation's environment. Any other approach is like rearranging the deck-chairs on the Titanic; the HSE ship is sinking, moving chairs around won't change that. Fiddling with pay and conditions, blaming or penalising or even killing the owners for the lousy performance of the system itself is not an answer. It is not fit for its supposed purpose, bin it.
Since Mary Harney invented the HSE some years ago in order to take the pressure off politicians for piss-poor country-wide health performance, the resultant monster is unsuitable as a vehicle to deliver world class/best in class medical care for its owners, the citizens of this country. It is simply a dog for the politicoes to kick come election time or come the next disaster its employees create.
Let's say for example we came up with a simple purpose statement that read something like "To deliver world class health-care to the citizens of Ireland, in a timely and effective manner" it'd go a long way to simplifying the various bureaucracies they've created for themselves that do nothing to fulfil that or a similar purpose.
Since Mary Harney invented the HSE some years ago in order to take the pressure off politicians for piss-poor country-wide health performance, the resultant monster is unsuitable as a vehicle to deliver world class/best in class medical care for its owners, the citizens of this country. It is simply a dog for the politicoes to kick come election time or come the next disaster its employees create.
Let's say for example we came up with a simple purpose statement that read something like "To deliver world class health-care to the citizens of Ireland, in a timely and effective manner" it'd go a long way to simplifying the various bureaucracies they've created for themselves that do nothing to fulfil that or a similar purpose.
It seems that you haven't heard back yet.
I am sure you will and in fact I think you have every chance of being successful.
Great, first ask the unions what they want then, ask the patients what they want, especially those who have trouble turning up for appointments, after all they are probably benefitting less that those who do turn up.
Hear Hear, the problems are down to the fiddlers, the deck chair movers and the critics.
And of course blame the politicians.
Now we are getting to the heart of it, a proposal to move ahead, just what is needed a slogan, sorry "simple purpose statement". The HSE will love it. I am sure you will get the job.
No, freeze all pay & conditions for all employees.
No, the slogans are the "mission statements" plastered up at the entrances to HSE facilities all over the country. Each one is different and makes no reference back to a purpose statement developed by the owner.
Your principled stand on freezing pay and conditions mathepac is likely to be sorely tested in the likely event that your application is successful as your annual salary is set to increase by €50,000 to €300,000.
Fear not you will not be alone as consultant salaries are set to increase and the HSE funded bodies whose salaries were cut in line with the public service cuts are surely set for comparable pay restoration.
And then there is the prospect of nurses and midwives strikes !
Fear not you will not be alone as consultant salaries are set to increase and the HSE funded bodies whose salaries were cut in line with the public service cuts are surely set for comparable pay restoration.
And then there is the prospect of nurses and midwives strikes !
Before the dust settles the people of Ireland will be spending about a half a billion less on health services because that money will be spent instead on healthcare wages. We spend more per capita on healthcare than almost every other country in the world. That despite the fact that we have one of the youngest populations in the developed world so should be spending considerably less. Out of that massive budget we spend a higher proportion on wages than just about anyone else.
Therefore the problem is structural. Just about everyone agrees on that. Yet nothing really changes. Why?
People don't want to work in our rotten system so our solution is to pay them more to put up with it. I think a better solution is to fix the system so that people want to work in it.
I know two nurses who have moved to England to work. Both said the money is about the same or worse but the job is easier because the structures are better and the ongoing training is far better. Maybe if we treated nurses better they wouldn't want a pay increase. The best way to reduce workplace stress is to make the structures people work within as efficient as possible. Maybe that's where we should to concentrating.
Therefore the problem is structural. Just about everyone agrees on that. Yet nothing really changes. Why?
People don't want to work in our rotten system so our solution is to pay them more to put up with it. I think a better solution is to fix the system so that people want to work in it.
I know two nurses who have moved to England to work. Both said the money is about the same or worse but the job is easier because the structures are better and the ongoing training is far better. Maybe if we treated nurses better they wouldn't want a pay increase. The best way to reduce workplace stress is to make the structures people work within as efficient as possible. Maybe that's where we should to concentrating.
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I'm a fan of increasing pay as efficiency is increased. If two people can do a job that used to require three people then the saving should be shared; they should get a proportion of the pay the third person used to get.
RETIRED2017
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If all 3 were already working inefficieent increasing pay for 2 beyond the market rate is madness, I think you will find your solution is the cause of many problems in the HSE,
A task used to require 3 people to do it. The process by which the task is completed has been improved (changed to be done with less work) so now that same task can be done by 2 people. In that case I would pay the two people a bit more; share the gain.
If people knew that they would get a pay increase if they increased efficiency then they would be more likely to lead the change.
Can I quote two recent family examples of why nurses (for example) should be paid less and why we have demonstrably too many of them.
My sister was admitted to A&E in a large Dublin hospital. Her experiences over 72 hrs in agony on a trolley in A&E before getting medical treatment changed her opinion of nurses, nursing and the HSE. Forever. Several people were admitted to the trolleys during her stay and she observed a number of nursing handover meetings as shifts changed. Not once during the handovers she observed were patients mentioned. The topics for discussion were: car insurance, holidays, who got off with whom at the week-end, who had the worst hangover, etc. Meanwhile an elderly woman with a broken arm/wrist moaned in pain for hours in the cubicle next door to her, with no treatment and no words of comfort.
At one stage my sister was told she needed a canula inserted in order to have dyes injected before having a scan/x-ray. She waited patiently to have this procedure carried out and the next thing she knew, a nurse was trundling her trolley to the imaging queue/section. She protested at being moved without her canula but she might as well have been talking to the wall. She joined a queue where she waited for several hours before being told she needed to have a canula inserted before being treated!
My grandson has ongoing medical needs and amongst them is a dire need to have a feeding tube inserted in his tummy because the current naso-gastric tube is problematic. His consultant 180 kms from Dublin referred him to a consultant in a Dublin hospital, where his name joined the queue for treatment. A letter duly arrived notifying them of their date for assessment for suitability to have the procedure carried out. Daddy booked time off work, Mammy booked their daughter into Granny's for a couple of nights and off they journeyed to Dublin with one overnight.
Checking in at the hospital next day they joined the inevitable queue for a few hours and when the consultant saw them it was with the news that the hospital concerned no longer carried out the procedure my beautiful little man needs.
No-one cares about patients, the purpose of the HSE is to pay huge wedges of money to people whose only motivation is to earn more - time-servers, not life-savers. This is why I know the HSE needs repurposing because the staff see it as fulfilling one need, money, and patients see it as a source of decent health care delivered by professionals.
[edited: fixed a couple of typos - no need for "canals" in my sister's hand]
My sister was admitted to A&E in a large Dublin hospital. Her experiences over 72 hrs in agony on a trolley in A&E before getting medical treatment changed her opinion of nurses, nursing and the HSE. Forever. Several people were admitted to the trolleys during her stay and she observed a number of nursing handover meetings as shifts changed. Not once during the handovers she observed were patients mentioned. The topics for discussion were: car insurance, holidays, who got off with whom at the week-end, who had the worst hangover, etc. Meanwhile an elderly woman with a broken arm/wrist moaned in pain for hours in the cubicle next door to her, with no treatment and no words of comfort.
At one stage my sister was told she needed a canula inserted in order to have dyes injected before having a scan/x-ray. She waited patiently to have this procedure carried out and the next thing she knew, a nurse was trundling her trolley to the imaging queue/section. She protested at being moved without her canula but she might as well have been talking to the wall. She joined a queue where she waited for several hours before being told she needed to have a canula inserted before being treated!
My grandson has ongoing medical needs and amongst them is a dire need to have a feeding tube inserted in his tummy because the current naso-gastric tube is problematic. His consultant 180 kms from Dublin referred him to a consultant in a Dublin hospital, where his name joined the queue for treatment. A letter duly arrived notifying them of their date for assessment for suitability to have the procedure carried out. Daddy booked time off work, Mammy booked their daughter into Granny's for a couple of nights and off they journeyed to Dublin with one overnight.
Checking in at the hospital next day they joined the inevitable queue for a few hours and when the consultant saw them it was with the news that the hospital concerned no longer carried out the procedure my beautiful little man needs.
No-one cares about patients, the purpose of the HSE is to pay huge wedges of money to people whose only motivation is to earn more - time-servers, not life-savers. This is why I know the HSE needs repurposing because the staff see it as fulfilling one need, money, and patients see it as a source of decent health care delivered by professionals.
[edited: fixed a couple of typos - no need for "canals" in my sister's hand]
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Under current terms and conditions that cannot possibly work as the third person in this example cannot be made redundant except if they qualify to opt for an extremely costly voluntary redundancy
Very interesting story mathepac, and not at all what we see reported in the media.
Indeed but people retire and people leave of their own volition (2000 to 3000 per year). There are no overnight fixes here; the big fix is thousands of small fixes.
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I don't agree. The thousands of small fixes are devouring many, many millions annually and show no improvements from a patient perspective, in many respects performance has worsened, costs have increased, with queues lengthening and outcomes not improving one iota.
I accessed a few HSE internal and Government documents and made some discoveries in line with my own observations.
We have too many nurses. Measure the number any way you like, but we have:
Overall, at the end of 2017, HSE employment levels expressed as whole-time equivalents, WTEs, stood at 110,795 up from 96,582, or a 15% increase from the start of 2014, that's an increase of 14,213 for the entire 4-year period, with no improvement in outcomes for patients.
Let me quote from the report I used as reference for this post*
"In recent years there has been a reocurring [sic] trend in recruitment toward the end of the year as monthly HSE recruitment increases significantly in the final three months of the year. In the final quarter of each of the last three years [2015 - 2017], the HSE has recruited on average an additional 1,432 staff. This level is around 40% of the HSE annual increase in employment over just a three month period. This recruitment in the final months of the year does not have a substantial impact on expenditure in that year, but rather has a significant impact in the following year as the expenditure pressure is essentially carried over."
and
"While the overall population in Ireland is growing, the age structure of this population is relatively young. In 2015, the old-age dependency ratio in Ireland was 20% compared to 33% in Germany. Demographic pressures on health services in Ireland are therefore much lower than other European countries with elderly populations."
More to follow.
*Spending Review 2018, HSE Staffing Levels: Management and Sustainability, July 2018
I accessed a few HSE internal and Government documents and made some discoveries in line with my own observations.
We have too many nurses. Measure the number any way you like, but we have:
- Too many nurses employed per head of population
- Too many nurses employéd per doctor employed
- Too many nurses employed in comparison to other OECD countries
Overall, at the end of 2017, HSE employment levels expressed as whole-time equivalents, WTEs, stood at 110,795 up from 96,582, or a 15% increase from the start of 2014, that's an increase of 14,213 for the entire 4-year period, with no improvement in outcomes for patients.
Let me quote from the report I used as reference for this post*
"In recent years there has been a reocurring [sic] trend in recruitment toward the end of the year as monthly HSE recruitment increases significantly in the final three months of the year. In the final quarter of each of the last three years [2015 - 2017], the HSE has recruited on average an additional 1,432 staff. This level is around 40% of the HSE annual increase in employment over just a three month period. This recruitment in the final months of the year does not have a substantial impact on expenditure in that year, but rather has a significant impact in the following year as the expenditure pressure is essentially carried over."
and
"While the overall population in Ireland is growing, the age structure of this population is relatively young. In 2015, the old-age dependency ratio in Ireland was 20% compared to 33% in Germany. Demographic pressures on health services in Ireland are therefore much lower than other European countries with elderly populations."
More to follow.
*Spending Review 2018, HSE Staffing Levels: Management and Sustainability, July 2018
They are not the fixes. There needs to be one plan with specific targets but many actions to reach those targets. When a change is proposed the question "does this get us closer to out targets?" should be asked. If the answer is no then don't do it. Organisations improve when they set the correct goals and are ruthless in their pursuit of those goals.
The HSE suffers from a lack of clear goals and strategy along with a lack of understanding at a regional level that the nurses and doctors and managers and administrators working at that local level are the HSE. It is not some nebulous thing up in Dublin, it is them and they are it.