Making Sense of Health Care Planning in Ireland; the Street Level Public Organization (SLPO).

Abstract

One of the central mechanisms of the Strategic Management Initiative (SMI) (Government of Ireland 1996) is the devolution of accountability and responsibility from the centre to executive agencies. Service planning was introduced in the Irish health care sector as part of this strategic planning ethos. This paper reports on a study that examined both the intent and the consequences of implementing legislatively mandated planning in the Irish health services, in the context of significant organizational change. In an effort to draw broader lessons, a comparison is drawn with the Canadian experience of service planning. The choice was made to study the dynamics of this policy implementation at a local level by examining a number of health boards in both the Irish and Canadian contexts, as well as accounting for the wider institutional influences; the environment in which those cases were situated. This wider view included looking at other stakeholder perspectives, including government and other health care organizations in the health care system, and examining the legislative influence. This study highlights a number of issues. First, the limits of the control system; the legislation itself, in aligning government policy aims with the planning process, and, second, the lack of recognition of the complexity of the healthcare environment and the stakeholders within it, in attempting to implement policy. This paper posits explanations for the difficulty in aligning strategy and planning in Irish health care after over a decade of service planning.