No. We have very high minimum wage levels and even higher levels of social transfers. We also have a large cohort of the workforce which is very underskilled. That's where we should be spending money.Is there no consideration to be made that perhaps low paid private sector workers are underpaid?
No, it's apparent that there is a shortage of housing and it is blindingly obvious that increasing money supply without increasing housing supply will just push up prices even more.Considering increasing homelessness, considering the amounts of people in receipt of rent supplement, FIS, etc is it not becoming apparent that the incomes of low paid are increasingly insufficient?
Okay, so?Certainly DOB only last June pointed to a growing lean, competitive economy that wasnt manifesting in wage increases in the private sector.
Nope, just asked to participate as someone from industry who worked with University Start-up's and had some dealings with Science Foundation Ireland. T'was a brief affaire.That sounds like you were part of a lobby group?
Right, so structural deficiencies in the day to day running of hospitals, the failure to identify, define and implement best practice is a failure of policy and not management... and that’s not bogus?
Why, does nobody in the health service or local authorities have the wit or intellect to improve anything?
Don't worry. We have the solution:Why, does nobody in the health service or local authorities have the wit or intellect to improve anything?
No. We have very high minimum wage levels and even higher levels of social transfers. We also have a large cohort of the workforce which is very underskilled. That's where we should be spending money.
No, it's apparent that there is a shortage of housing and it is blindingly obvious that increasing money supply without increasing housing supply will just push up prices even more.
Don't worry. We have the solution:
Typical default answer by people who are unwilling to admit that they are part of the problem. Contemptible.Every organization has inefficiencies. If you can identify specific examples then those can be addressed if valid
A&E unit are overcrowded because there isn't anywhere to put the people who have been seen, not because they can't get through the workload in the A&E departments. We spend more than just about everyone else on healthcare and, despite having a very young population, have some of the worst waiting lists and overcrowding problems. And you're telling me there's nothing wrong with the structures, the processes and the work practices; it's all down to ideology. You're telling me that having consultants on call to discharge patients and better step-down facilities won't alleviate the problem and save money, no, it's all down to ideology. Claptrap.If a&e units are overcrowded every Saturday night because of an influx of intoxicated drink and drug revellers, what is the answer?
There are 102,000 people working for the HSE (about 1 in every 20 people who works in Ireland). 67,000 are direct employees and 35,000 work for agencies which are funded by the HSE. That doesn't include those working in the multi-billion Euro private healthcare sector in this country.There are some 60,000 people working in the HSE.
And you're telling me there's nothing wrong with the structures, the processes and the work practices; it's all down to ideology.
You're telling me that having consultants on call to discharge patients and better step-down facilities won't alleviate the problem and save money,
I have never spoken to a nurse or doctor or other employee in the HSE who thinks it is a well structured and well run organisation
Go through the admission process in a few Irish hospitals and you'll see that some are much more efficient than others.
If you work in an inefficient system or process then you are inefficient. Being inefficient is not the same as being slow or being lazy or being bad at your job. It is a reflection of the process or activity, not the person carrying out that activity. You seem to be unable to understand that. Why?Im guessing that very few would describe themselves as inefficient. Im guessing that they can spot inefficiencies, which is different.
If you work in an inefficient system or process then you are inefficient.
No, the person working an inefficient system is inefficient. They may well be getting the best possible output from the system as constructed but their output is still much lower than it could be. Therefore they are inefficient. They can be working their ass off but they are still inefficient.Ok we are in danger of splitting hairs here. I would suggest differently.
If a worker can carry two boxes at a time but the system says he should only carry one, then if the worker carries one box at a time they themselves are not inefficient. They are simply doing what it is that they are required to do.
The system is inefficient, but the person working in it is not (take your nurses and doctors for example).
The root cause of the inefficiency is the process (job holder is a new term to me) but everything that happens after that is inefficient. It is not possible to be efficient while operating in an inefficient process.The inefficiency lies with the job holder (typically management) who decided only one box is to be carried even though two could be carried.
You just don't understand what I'm saying.That is why I dislike your broad sweeping generalisations.
Agreed; the big solution is usually thousands of small solutions. There aren't just many thousands of processes within the health service but there are many versions of each of those processes. The first step it to identify them and decide which version is best and just use that version. The hospitals under the RCSI are doing this, to a limited extent, but no others. I think there is a role for HIQA in that area since quality should mean the process quality. I often point out to people that ISO:9001 isn't about the management of your quality system, it's about the quality of your management system. A good management system looks for efficiency on an ongoing basis. Anything else is not fit for purpose.There are many thousands of different processes throughout the health service. Between providing best available care and value for money I would imagine it is a huge task. That said, no reason why it cannot be achieved.
You just don't understand what I'm saying.
That's because you have an ideological problem with a criticism of a process or procedure without a caveat explicitly exonerating the "wurker" carrying out the task. It's just public service defensiveness.That is my sentiment, only if a worker is signed up to do a process a certain way, and they complete that process I would describe them as efficient at what they are tasked to do.
I agree. It is usually management who resist change. Add to that Unions in the Public Sector who want more money for every change and the chance of improvement is minimal.I've lost count the number of times efficiency is blocked for no good reason, public and private. Some people (often management) are simply change proof.
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