Lack of continuity at top of HSE threatens quality improvement

Institutional memory is the collective knowledge and learned experiences of a group. It is a way for an institution to connect what has worked well in the past, with what could work well in the future. Losing key staff members with in-depth familiarity of a given area poses a threat to the continuity needed for an organisation to thrive. This has been a constant problem for the HSE. There has been significant staff turnover at a senior management level over the last number of years. In just over a year, the HSE has had four Director Generals (DGs). Take Mr John Connaghan, one of the two interim DGs during this period. After working in the NHS in Scotland for many years, Mr Connaghan was appointed as Chief Operations Officer and Deputy Director General in 2017. He took over as interim DG following the resignation of Mr Tony O’Brien during the CervicalCheck controversy. After only a few months in the role, Mr Connaghan decided to move back to Scotland. This story is all too common within the HSE.

Mr Tony O’Connell left his role as Director of Acute Hospitals in early 2015 to go back to work in the Australian health system, where he had worked before. He had been less than nine months in the position. One of the initiatives that Mr O’Connell established in his short time with the HSE was the Irish Hospital Redesign Programme (IHRP). The programme, which was piloted in Tallaght, was based on an initiative in Australia to improve patient flow. However, there was a leadership vacuum after Mr O’Connell went back to Australia. It took time for the IHRP to find its feet but when it did, a number of improvements were made to the way patients moved through the hospital. However, when the pilot ended, the IHRP lacked political support and was discontinued.

Although it was still in existence in 2015, the HSE went to tender for a similar initiative — the National Patient Flow Improvement Programme (NPFIP). As reported in this issue of the Medical Independent, Chair of the IHRP working group Mr Frank Keane criticised the decision to replace the programme, stating that important lessons would be lost. Although those behind the NPFIP claimed it was building on the work of the IHRP, it was essentially starting from scratch. The new programme, which was piloted in University Hospital Galway and University Hospital Limerick, encountered similar problems to the IHRP, such as a lack of resourcing and the loss of support due to the expectation of immediate results. NPFIP advocates such as Special Delivery Head Ms Grace Rothwell and HSE National Director for Clinical Strategy and Programmes Dr Áine Carroll are no longer in their roles. With the HSE also beginning yet another period of restructuring, the fate of the programme is uncertain. Although it achieved some progress in Galway, the pilot in Limerick was less successful.

The story of the IHRP and the NPFIP is symptomatic of the lack of joined-up thinking and continuity that has characterised the HSE since its establishment.