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

Reconciling External Legitimacy and Organisational Implementation

Vivienne Byers,

Dublin Institute of Technology

EHMA Conference

June 2008


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

  • 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

  • Planning, strategic management and accountability….

  • National Health Strategy

    Possible difficulties/ Propositions:

  • Legislation – the control mechanism

  • Organisational capacity


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

  • 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

  • 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

  • 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

  • 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?


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)


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 -

  • 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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