We finally know the truth about management incompetence in the Irish health services, and it is not pretty. The HSE recently published the findings of the firsthealth service employee survey on themes such as leadership and overall strategy. Commenting on the findings, Ian Tegerdine, the national director of human resources at the HSE, said: “The results, while disappointing in some areas, are not hugely surprising given that the health service has come through an incredibly challenging few years when there were unprecedented cuts in budgets and staff numbers.”
Not only is this a huge understatement, it ignores the survey’s abysmal findings on manager performance. In fact, cuts in budgets and staffing are not mentioned in the report, which confirms what citizens have long suspected: frontline health service workers do the best they can, and their managers are unable to manage.
A total of 8,627 health service employees (HSE and HSE-funded agencies) completed the survey and findings were benchmarked against relevant NHS (UK) and RED (Representative Employee Data) international norms. Irish health service managers, and in particular senior managers, are performing well below these norms.
‘Deteriorating’
In relation to leadership, fewer than one in 10 respondents agreed or strongly agreed with the statement “Change is well managed within the health services.” Only 12 per cent agreed or strongly agreed with the statement: “I have confidence in the decisions made by senior management.” More than half of respondents disagreed or strongly disagreed with the statements “Communication between senior management and staff is effective,” and “Senior management act on staff feedback.”
In relation to roles, nearly two-thirds said they do not have “all the equipment, support and resources I require to do my job correctly”. Only 16 per cent are satisfied with the extent to which the health services values and recognises their work.
Two-thirds of respondents believe that “overall service level is deteriorating”. Amazingly, almost half “don’t know the overall [health service] strategy well enough to say” whether it is heading in the right or wrong direction. More managers completed the survey (3,292) than any other group including nurses (2,043) and doctors/dentists (431), so it seems that managers are just as critical of their manager colleagues as are non-managers.
Do the people who commission these reports actually read and learn from them? No lessons can be learned if the findings are promptly ignored, misinterpreted or reinvented. Blaming budgets and staffing for problems caused by bad management will not solve anything. The HSE now proposes to organise countrywide focus groups “to get further detailed input from employees on key issues highlighted in the survey”. These focus groups will be a waste of time and energy, and frustrate those who answered the questionnaire and gave their views in good faith.
Better care
The report is unequivocal in relation to poor manager performance: it could hardly be worse. In summary, health service managers, and in particular senior managers, are not trusted, do not listen, cannot manage change, do not communicate effectively, and do not adequately support frontline staff to do their job. Focus groups will not reveal anything new. Health service workers will just become more cynical about management, thus widening the gap between us (frontline) and them (the managers).
This survey is important and credit is due to the HSE for funding it and publishing it in full. Acting on the real (poor management), not the fictitious (cuts and staffing levels) findings will improve the way services are delivered, leading to better health outcomes.
The HSE Corporate Plan 2015-2017 states: “Evidence shows that happy, well-motivated staff deliver better care and that their patients have better outcomes. We will work to make it possible for all staff to do the best job they can.” It is now time for action.
What about using the funding for the proposed focus groups to buy the equipment needed by frontline staff? Maybe HSE senior managers could issue a statement acknowledging the findings and promising to do better in future? A starting point would be to ensure all employees understand the overall strategic direction of the Irish health services.
Several visions, missions and strategic statements have been developed, written down and disseminated since the HSE was established 10 years ago, and it is extraordinary that nearly half of the employees do not know this strategy well enough to comment on its general direction. Organisations cannot function unless everyone working in the organisation understands where it is going. And all health service workers, not just managers, are to blame for their own ignorance. drjackyjones@gmail.com
Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.