Leo Kearns, National Lead for Transformation and Change, Health Service Executive

West North-WestHospital Group

Conference 2014“Reforming the Health Service”

Leo Kearns, National Lead for Transformation &

Change

Thursday, 9th October 2014

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

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

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.

AcutePrimary Mental Health

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

Human Resources – culture, workforce planning, recruitment

ICT/eHealth – systems and data flow to enable

Service Improvement

change managementperformance improvement geographic,

cross boundary,

transition to BAU

Making Connections

Performance Indicators/Assurance – aligned measures

Inform & Implement PolicyD

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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]

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

“it’s time for a fundamentally new strategy”

Michael Porter & Thomas Lee, 2013

One that focuses on maximising value for patients: that is achieving the best outcomes at the lowest cost

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

“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

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 ……..




For Each Programme• Vision and Objectives?• Plan, Timelines, Deliverables?• Communication Strategy? • Resource Strategy?• Interdependencies?• Expertise required?• Governance & Management?






HSE Leadership Reform Steering Group – Health Reform Board in DOH

For Each Programme• Vision and Objectives?• Plan, Timelines, Deliverables?• Communication Strategy? • Resource Strategy?• Interdependencies?• Expertise required?• Governance & Management?





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

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

Establishment of Integrated Care ModelClinically-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

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

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

Challenges to Reform

“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

“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

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

Health & Medicine

Leo Kearns, National Lead for Transformation and Change, Health Service Executive