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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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