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Welcome
Richard DooleyPresident, HMI
Agenda
• Opening Address– Dr. James Reilly TD, Minister for Health
• New Policies, New Practices– Chair: Liam Duffy
Chief Executive, Beaumont Hospital
• The Challenge for Managers– Chair: Derek Green
Chief Executive, National Rehabilitation Hospital
Thanks to our Sponsors
Conference Housekeeping
• Conference papers/delegate list
• Mobile phones
• Safety
Dr. James Reilly, TDMinister for Health
New Policies, New Practices
Chair: Liam Duffy
Heinz KölkingPresident, EAHM
Leading Change in Challenging Times
European Healthcare Funding Strategies
European Healthcare Funding Strategies
1.1. Mega trendsMega trends
2. Health economy in the future:
3. Frame an fields of activities
Societal development
Globalisation
Demographie
Medical progress
Development of the economy
Mega trends in the healthcare as challenge for hospitals
Thesis 1:
The terminology of healthcare economy stands for the change in healthcare!
Mega trends in the healthcare as challenge for hospitals
Thesis 2:
Society an economy need a growing, but efficient and effective healthcare in the broadest sense possible!
Mega trends in the healthcare as challenge for hospitals
Thesis 3:
Services determine the development of the economy and of the employment in the future!
European Healthcare Funding Strategies
1.1. Mega trendsMega trends
2. Health economy in the future:
3. Frame an fields of activities
Development of the health economy
Vision: Quality healthcare (medical progress, demography, economic development, globalisation)
Goals: Quality, Efficiency and effectiveness
General principles: Transparency, competition, service orientation, crosslinking, patient centred care, responsibility for oneself and solidarity
Instruments: DRGs; new forms of treatment; disease management programmes, medical care centers
Safeguarding the future
European Healthcare Funding Strategies
1.1. Mega trendsMega trends
2. Health economy in the future:
3. Frame an fields of activities
Results
Processes
Services offered
Structures
Factors of success
Capacity utilisation
Profits
Quality
Cost effectiveness
Investment
Driver for efficiency and effectiveness
Common public interest as driver
Return of investment as driver
Cost effectiveness and quality
Instead of lavishness
Outlines of the third sector(Source: Anastasiadis (2006)
statepublic authorities
MarketPrivate companies
Own work,household, familiy
public
privat
formal
informal
in c
omm
on p
ublic
inte
rest
max
imis
ing
profi
t
Thirdsector
Thank you!!!
Cathal Magee
Cathal MageeChief Executive, HSE
The Challenge of Health Service Reform
Cathal Magee
Chief Executive Officer
Health Service Executive
Context
• Population growth (17% since 2002)
• Ageing population– over 65s costs expected to rise by 2% each year for next 5 years
• Adults with chronic conditions will increase by 40% by 2020
• Invasive cancers projected to increase 6% annually for females and 8% for males
• Acute & non acute activity demand continues to rise
• Incumbent models of care struggling to keep up
Objective
• improve access to care
• improve the quality of care
• bring down the cost of care
Start with the basics
“The Good-to-Great companies had no name, tag line, launch event or programme to signify their transformation. Yet, they produced a truly revolutionary leap in results, but not by a revolutionary process.”
Jim Collins
“Good to Great”
Leading Change
• Where are we?
• Where do we want to go?
• How ready are we to go there?
• What do we need to do to get there?
• How do we manage the journey?
Where are we?
• Finance
• People
• Management
• Organisation
Finance
Irish Output
Source: CSO National Income & Expenditure 2010
Irish Public Health Expenditure
Source: Department of Health & Children. Health In Ireland: Key Trends 2010.
Irish Output and Public Health Expenditure
Public Health Expenditure as % GDP
Source: The National Recovery Plan 2011–2014. DoHC Key Trends 2010, CSO National Income & Expenditure accounts
Net Funding to HSE
Total Health Spend Comparisons - Per Capita
Source: OECD Health Data 2011.(based on 2009 figures)** The Irish data includes social expenditure which is estimated at 20% of total health expenditure.
20%**
People
Health Disciplines- 2011
35%
8%17%10
%15%
15%
Health & Social Care Professionals
Nursing
Medical/DentalManagement
/Admin
Other Patient
& Client Care
General Support
Staff
90,302 WTEs
112,771 WTEs
104,511 WTEs
Resource Levels 2001 -2011 – Health Service
Resource Levels 2001 -2014 – Health Service
Capacity – 2001 to August 2011
Staff Category
Change from 2001 to present
Change Sept 07 to 2011
Estimated Target
Change Sept 07 - 2014
Medical/Dental 27.15% -1.34%
98,750 (Est.)
Nursing 15.12% -7.14%
Health & Social Care Professionals 75.42% 2.70%
Management/Admin 9.19% -12.78%
General Support Staff -22.50% -19.88%
Other Patient & Client Care 17.13% -4.32%
Total - Health Services 15.74% -7.32% -12.57%
Health and Social Care Professionals2001 to 2011
Management/Admin – 2001 to 2011
Management/Admin
18,421 WTEs
16,066 WTEs
14,714 WTEs
Management
Management/Admin – August 2011
43%
27%
17%6%
4%
Management
• Administration is a required core competence
• Administration is not management
• Need to strengthen the management system
• Separate the career streams
• Investment in management a strategic priority
• Interim solutions required
Management
• Who is ‘Management’ in our health system?
– Management and administrative
– Medical leaders
– Nursing leaders
– Allied health professional leaders
Executive Management
• Line
• Operations
• Financial
• Procurement
• ICT
• HRM
Delivery
of
Clinical Services
and
Patient Care
Clinicians in Management
• Health services is a clinical environment
• Need reform in the actual delivery of healthcare
• Clinicians at the centre of re-engineering and managing
• Management to be core part of clinicians development
• Need to create and support an enabling environment
• Clinically led multidisciplinary team
• Structured programme management approach
• Nationalise existing best practice
• Engage patients
• Align stakeholders
• Make data driven decisions
• Local ownership of implementation
National Clinical Programmes
Scale of National Clinical Programmes
.
Unlocking High Performance in Healthcare
‘the leadership needed to transform the performance of hospitals and health systems must come principally from doctors and other clinicians whether or not they play formal management roles’
McKinsey & Co.
Organisation
Hierarchical Creative
Bureaucracy Start Up Phase
High
Low High
Discipline
Change
HSE
• Scale, scope, complexity, geography
• Complexity of designing basic architecture
• Existing operating model too centralised
• Service delivery requires local leadership
• ‘Ownership’ in the frontline
• Frontline to be connected, responsive, authoritative
Unbundle & Invert
Policy
Planning & Commissioning
Enterprise Support / Shared Services
Hospital / Health Care Networks
Front Line Delivery Units
The Challenge of Sustainability
• Economic– public health services spending with reference to our ability to
fund
• Delivery of services– the capacity of health services to come through the reductions in
money and people
• Change– change which will protect and improve our health services
The Challenge of Sustainability
• Traditional “steps” to reform will not work
• Changing the way we change
• Concurrent action based strategic management
• Maintain focus on services to patients and clients
“The Good-to-Great companies paid scant attention to managing change, motivating people or creating alignment. Under the right conditions, the problems of commitment, alignment, motivation and change largely melt away.”
Jim Collins
Good to Great
New Policies, New Practices
Chair: Liam Duffy
Exhibitors
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