Abstract
Objectives: To appraise health system capability for transformation during economic crisis by exploring the impact of health service managers’ priorities, challenges and expectations. Methods: Survey of health service manager priorities and content analysis of health service manager semi-structured interviews with a final analysis of expectations using an organisational readiness lens. Results: Government priorities for health reform, even when shared by healthcare managers, are afforded little managerial time due to the pressures of ensuring service delivery during economic crisis as well as managing multiple organisational changes. In this situation managers are challenged by negative impacts on patient care, organisational fragmentation and the weak implementation of change. Manager expectations for organisational transformation are low. Conclusions: Health system transformation is unlikely given the range of complex priorities requiring attention from managers during economic crisis. Managers have little expectation of organisational transformation as they face considerable service delivery challenges while feeling under-resourced and unsupported. Adequate resourcing of communication and leadership for change is critical.
Highlights
Health system re-organisation is a common approach to healthcare reform aimed at better managing demographic shifts, changes in the health-burden profile, healthcare technologies, public expectations and the need for efficiency and sustainability in health service delivery [1, 2]
In line with international trends the Irish health system is undergoing major re-organisation. Some of these changes are driven by the desire to deliver on policy commitments while others are oriented towards greater operational efficiency and coherent service delivery. These organisational changes come on the back of the international financial crisis and its negative impact on health reform in many
The financial crisis contributed to a health resourcing crisis which in turn further complicated an ongoing organisational crisis
Summary
Health system re-organisation is a common approach to healthcare reform aimed at better managing demographic shifts, changes in the health-burden profile, healthcare technologies, public expectations and the need for efficiency and sustainability in health service delivery [1, 2]. In line with international trends the Irish health system is undergoing major re-organisation Some of these changes are driven by the desire to deliver on policy commitments while others are oriented towards greater operational efficiency and coherent service delivery. These organisational changes come on the back of the international financial crisis and its negative impact on health reform in many. The financial crisis contributed to a health resourcing crisis which in turn further complicated an ongoing organisational crisis This crisis was manifest in the departure of high calibre professionals from the health system, absenteeism, low staff morale, a blame culture, lack of investment in technology and management systems, and greater levels of bureaucracy, fragmentation and change-fatigue – all outcomes reported in our data
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