Planning in the irish health services
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Planning in the Irish Health Services. Reconciling External Legitimacy and Organisational Implementation. Vivienne Byers, Dublin Institute of Technology. EHMA Conference June 2008. Context – Need for Planning.

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Planning in the Irish Health Services

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Planning in the irish health services

Planning in the Irish Health Services

Reconciling External Legitimacy and Organisational Implementation

Vivienne Byers,

Dublin Institute of Technology

EHMA Conference

June 2008


Context need for planning

Context – Need for Planning

  • Irish spending on health has gone from 15 per cent below the OECD average to 17 per cent above in the period 1997-2003 (Source: Department of Health & Children 2005)

  • However, spending of 7.1% GDP lowest of EU15 (source: OECD 2006)

  • Life expectancy 2nd lowest in EU15 after Portugal (source: OECD 2006).

  • After a decade of exceptional economic growth.

  • Debate over the value for money that the health service

  • Recent public service review


Overview planning in health

Overview – Planning in Health

  • Past as prologue

  • Strategic Management Initiative

  • Health Care Strategies 1994 & 2001

  • The 1996 Health (Amendment) Act No 3 and its successor 2004 Health Act

  • Strategic Planning

  • Service Planning


Research focus

Research Focus

  • Planning, strategic management and accountability….

  • National Health Strategy

    Possible difficulties/ Propositions:

  • Legislation – the control mechanism

  • Organisational capacity


Planning in health care

Government: General Legislation

Resource Allocation,

Organizational Structure,

Performance Measurement.

B

A

Street Level Public Organisation (SLPO):

Health Board/HSE area

Client-Citizen;

Professions: ‘Rules of the Game’

C

Planning in Health Care

  • The Street Level Public Organisation (SLPO) (McKevitt 1998, Byers and McKevitt 2007)


Case study organizations

Case Study Organizations

  • A comparative study 2004-2005

  • This presentation reports on part of a wider study

  • Phase 1: Examination at Health Board/Regional Level in Ireland

  • Observation & Analysis of documents/archives


Some findings

Some Findings

  • A number of key issues emerged

    • Health professionals

    • Managers

  • Two of the themes identified will be used to underpin the key propositions established at the outset

    • Determination of Service levels and needs

    • Stakeholder Representation


Determination of service levels and needs

Determination of Service levels and needs

  • The service planning legislation is meant to facilitate strategic planning;

    • Health professionals – priorities not based on needs analysis but on historically based budgets

    • Frustration, powerlessness, lack of IT support to gather data

    • Managers – Clean sheet reviews not feasible, control process politically influenced. Needs analysis not seen as priority.

  • Disconnection of Management from Operating Core

    • Control


Stakeholder representation

Stakeholder Representation

  • The service planning legislation is meant to facilitate strategic planning through devolved decision making;

    • Health professionals – Stakeholders in the process? Relations with government at an all time low. In establishing ‘rules of the game’ some had withdrawn from the process. ‘Real planning’ exercises.

    • Managers – Difficulty in engaging health professionals in the process. In many cases ‘planning can be done well enough without them’.

  • Again, disconnection of Management from Operating Core

    • Organisational Capacity to plan?


Slpo model needs analysis

Government: General Legislation

Resource Allocation,

Organisational Structure,

Performance Measurement.

B

Street Level Public Organisation (SLPO):

Health Board/HSE area

SLPO Model – Needs Analysis

  • Control System – Look at legislation for guidance as to the service planning process.

  • Core theme of needs analysis identified would assist in strategically driven resource allocation in line with principles of the national Health Strategy.

  • This had not occurred because these principles were not explicit in the legislation (results in a break or point of tension at B)


Slpo model stakeholders

Government: General Legislation

Resource Allocation,

Organizational Structure,

Performance Measurement.

A

Professions: ‘Rules of the Game’

Client-Citizen;

C

SLPO Model – Stakeholders

  • Divisions between management and health professionals stark

  • SP used as a control mechanism rather than an inclusive planning process (see Point A)

Street Level Public Organisation (SLPO):

Health Board/HSE area

  • Point C: Thus, Professions are often blamed for weaknesses in the system


Conclusion

Conclusion -

  • SLPO Model

    • Nexus of relationships is not acknowledged

    • Therefore, the health professional and citizen-client not involved in the process

    • This results in lack of needs based planning.

    • Reliance on the service planning legislation means it remains a budgetary exercise

  • Inconsistency

    • Legislation has purely control focus

    • Organisational capacity to change is limited partly due to breakdown in relationships

  • Real Planning – What business are we in?

    • Budget control?OR

    • Provision of services for the citizen?


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