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More cuts in health spending
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In your example of the porter manager if he's shrugging his shoulders and not working to communicate and resolve the problem with his counterpart in the other department (whom he probably greets every day) then he's permitting extra unnecessary work for all the other staff and complications like bed sores for patients.
Not to labour the point, but there direct and indirect consequences of each and every action or inaction..
There are huge waiting lists for MRI scans.. his slot remained unused, and had to be rebooked which further extended the waiting list. The indirect consequence of lots of actions like that are I (and many others including him) spend 6-8 unnecessary days in hospital (luckly I can easily afford private cover so therefore I get done) and others less fortunate don't even get to see a bed in a reasonable time because a consultant prefers me paying €935 + €75 per day rather than only €75 for public patients. Despite the seriousness of my condition, I didn't need to be there and someone else who needed to be in a bed should have been there... I was actually down in Coolock cinema killing time (i think watching Snow White gave me the brain tumor
).
We got a phone call on last Thursday evening saying our appointment with the consultant for the next day had been cancelled due to emergency surgery. My wife explained noone had told us we were booked in for an appointment (we dont live in Dublin).. The nurse sighed as it's another department who are supposed to do the bookings, and these issues happen so often now then a consultant and their team are left standing around with no patients to give updates to because noone tells the patient to come back to the hospital.. End result, consultants time (and nurses, doctors etc who accompany them) is doubled (and they are not available or booked to provide treatment during these sessions) as they need to come back in again to tell me if I am going to die.. The consultant will now only meet patients on a single day per month. In 12 weeks I will find out if I am dying.. assuming "the other department" remembers to ring me
Its a continual cycle of waste and cost that really can be fixed by low level management and staff.. As another patient commented to the Dept head when I was there.. The left hand doesn't know what the right hand is doing, and in most cases.. doesn't care..
Edit - I should add for clarity.. the vast majority of staff I encountered were wonderful.. they work hard and long hours (somewhat headless chicken though). However the bulk of their issues, pain and waste is caused by this department by department isolation that means 10 people across different departments need to be involved in getting a clean towel for a guy who hasnt been washed in a week.. because walking across and grabbing it from the shelf 50 feet away would cause organisational uproar and cannot be allowed to happen. His well being or concern is not part of the equation.. I have never worked for an organisation globally (in over 30 years) who have ever considered working like that, nor would it be tolerated.0 -
Not to labour the point, but there direct and indirect consequences of each and every action or inaction..
There are huge waiting lists for MRI scans.. his slot remained unused, and had to be rebooked which further extended the waiting list. The indirect consequence of lots of actions like that are I (and many others including him) spend 6-8 unnecessary days in hospital (luckly I can easily afford private cover so therefore I get done) and others less fortunate don't even get to see a bed in a reasonable time because a consultant prefers me paying €935 + €75 per day rather than only €75 for public patients. Despite the seriousness of my condition, I didn't need to be there and someone else who needed to be in a bed should have been there... I was actually down in Coolock cinema killing time (i think watching Snow White gave me the brain tumor).
.
First off I hope you are recovering well after your treatment and continue to do so and not have to experience the list of grievances you outlined earlier again any time soon.
While I am in full agreement that the system needs to be reformed from top to bottom to consign to the dustbin the inefficient and downright ridiculous practices that prevail in hospitals I am firmly of the belief that such reform has to start at the top. Many of the ridiculous practices re: patients remaining in beds unnecessarily and confusion over appointments stem from the fact that consultant control who, when and for how long a patient stays in a hospital. This is compounded by the public/private mix and the existence of 2 waiting lists based on whether you are a public or private patient. In a public hospital the administration has to operate these 2 distinct streams of patients at no cost to the consultant. Its a bit rich sometimes when I hear consultants complain about their patients not been treated appropriately when these guys expect the public patient to 'yield' to the private patients and expect the taxpayer to pay for the administration of private patients for the financial gain of the consultants.
Like any other reform, e.g. pay reform, it must start at the top to give example down the line. Getting rid of the two-tier system would not only simplify the administration of the system but ensure that all patients are treated fairly and according to their clinical need. It would also ensure that consultants work on-site in the hospital for all patients for the required period and not be off tending to the needs of a certain cohort. No other country, to my knowledge, operates like ours in this context and if we were on top of the quality chart I'd say fair play... but we're not so its high time we looked at the big picture and introduce fundamental organisational reform to the system which would then trickle down to deal with the operational nonsense that goes on in the system.0 -
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First off I hope you are recovering well after your treatment and continue to do so and not have to experience the list of grievances you outlined earlier again any time soon.
While I am in full agreement that the system needs to be reformed from top to bottom to consign to the dustbin the inefficient and downright ridiculous practices that prevail in hospitals I am firmly of the belief that such reform has to start at the top. Many of the ridiculous practices re: patients remaining in beds unnecessarily and confusion over appointments stem from the fact that consultant control who, when and for how long a patient stays in a hospital. This is compounded by the public/private mix and the existence of 2 waiting lists based on whether you are a public or private patient. In a public hospital the administration has to operate these 2 distinct streams of patients at no cost to the consultant. Its a bit rich sometimes when I hear consultants complain about their patients not been treated appropriately when these guys expect the public patient to 'yield' to the private patients and expect the taxpayer to pay for the administration of private patients for the financial gain of the consultants.
Like any other reform, e.g. pay reform, it must start at the top to give example down the line. Getting rid of the two-tier system would not only simplify the administration of the system but ensure that all patients are treated fairly and according to their clinical need. It would also ensure that consultants work on-site in the hospital for all patients for the required period and not be off tending to the needs of a certain cohort. No other country, to my knowledge, operates like ours in this context and if we were on top of the quality chart I'd say fair play... but we're not so its high time we looked at the big picture and introduce fundamental organisational reform to the system which would then trickle down to deal with the operational nonsense that goes on in the system.
I agree 100%.. I just want to make sure that people really do understand that Yes, change needs to happen at the top, but it equally needs to happen at the bottom. Each and every member of the HSE can tell you of rediculous practise they have to deal with each and every day.. but how many of them have made a stand, and how many HSE people have backed up that stand?
It's easy to blame the big guys, while also ignoring their attempted changes (strike ballots etc.).. but at some stage the whole organisation needs to take responsibility for each and every disfunctional part (and learn from the world class parts) and implement change.
As I said, I am lucky to get bumped to the front of the list becuase I am private (and will continue to be for that exact reason).. I couldnt imagine what it feels like to be sitting at home for months, while I am at the cinema "in your bed".... but how many of the low level managers, staff or union members have ever put their hands up to the issues I listed and tried to force the change they know is desperately needed? They have however gone to court to ensure swathes of unnecessary Admin staff were kept in place....
btw.. thanks for the kind responses.. and don't worry I wont be offended by equally strong arguements against my position i feel its time fair and honest discussion happened, and I do have some recent real experience to shed some light (and can blame a brain tumor if i am wrong /wink) 0 -
Not to labour the point, but there direct and indirect consequences of each and every action or inaction..
There are huge waiting lists for MRI scans.. his slot remained unused, and had to be rebooked which further extended the waiting list. The indirect consequence of lots of actions like that are I (and many others including him) spend 6-8 unnecessary days in hospital (luckly I can easily afford private cover so therefore I get done) and others less fortunate don't even get to see a bed in a reasonable time because a consultant prefers me paying €935 + €75 per day rather than only €75 for public patients. Despite the seriousness of my condition, I didn't need to be there and someone else who needed to be in a bed should have been there... I was actually down in Coolock cinema killing time (i think watching Snow White gave me the brain tumor).
We got a phone call on last Thursday evening saying our appointment with the consultant for the next day had been cancelled due to emergency surgery. My wife explained noone had told us we were booked in for an appointment (we dont live in Dublin).. The nurse sighed as it's another department who are supposed to do the bookings, and these issues happen so often now then a consultant and their team are left standing around with no patients to give updates to because noone tells the patient to come back to the hospital.. End result, consultants time (and nurses, doctors etc who accompany them) is doubled (and they are not available or booked to provide treatment during these sessions) as they need to come back in again to tell me if I am going to die.. The consultant will now only meet patients on a single day per month. In 12 weeks I will find out if I am dying.. assuming "the other department" remembers to ring me
Its a continual cycle of waste and cost that really can be fixed by low level management and staff.. As another patient commented to the Dept head when I was there.. The left hand doesn't know what the right hand is doing, and in most cases.. doesn't care..
Edit - I should add for clarity.. the vast majority of staff I encountered were wonderful.. they work hard and long hours (somewhat headless chicken though). However the bulk of their issues, pain and waste is caused by this department by department isolation that means 10 people across different departments need to be involved in getting a clean towel for a guy who hasnt been washed in a week.. because walking across and grabbing it from the shelf 50 feet away would cause organisational uproar and cannot be allowed to happen. His well being or concern is not part of the equation.. I have never worked for an organisation globally (in over 30 years) who have ever considered working like that, nor would it be tolerated.
Some great info there Welease.
Based on your posts, it seems reform has to start at the very, very top.
It looks like everyone is terrified of union action or a demarcation dispute.
The order has to come from the Minister himself, down to the HSE Chief and Union bosses, then down the chain of command.
I remember hearing from relatives that they wouldn't be allowed to change a light-bulb themselves or adjust the time on a wall clock in their own office themselves!!
It's little wonder they're so incredibly inefficient, but it must also be very demoralising having your work constantly obstructed in this way.
p.s. hope your health improves0 -
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Both
Well Yes, Yes and Maybe but not exactly (we are getting closer
)golfwallah wrote: »Yes and No again.
To limit the role of senior management to being merely: “responsible for dictating direction” is letting them off the hook. Granted you have a point that senior management alone can’t drive change by force and that change has to be driven by all staff members.
I don’t agree that “no single entity can be held responsible for fix it (because they can't alone)”. Through the democratic process in this country, Dr Reilly as minister has been entrusted with the mandate from the electorate to fix the Health Service. Certainly, he alone can’t do it, but that buck stops with him to initiate the change process and work with the key people involved to see it through.
One needs to keep in mind that survival is not compulsory and that to survive as a country on a much reduced budget, change is necessary – no matter how painful that may be.
I agree with you up to here, but I would slightly argue that its also the HSE's job to identify and implement change.. If we need Rielly to tell them not to make and deliver dinners to patients that are not in the hospital etc. then the whole staff chain needs to be replaced.golfwallah wrote: »My point is that the initiative for change has to start at the top – with Minister Reilly. Bad systems and processes will not change themselves. The process of change includes engaging with the unions to find ways to deliver better service for less money (including dealing with the thorny issues of restrictive practices, work demarcation and overstaffing).
One beneficial effect of the current recession is that it provides the climate needed to initiate long overdue business transformation in the health service. Shrinking availability of funds over the next few years gives us very little choice but to tackle growing problems that have been long-fingered for decades. The alternative of cutting services to preserve vested interests is unthinkable for the majority of Irish citizens and is no longer a soft “viable” option.
And this is where I was trying to highlight the issue in Ireland that everyone seems to prefer to throw the glaze upwards and blame senior staff (Rielly, Consultants etc.) and tell us how overworked many of the HSE staff are (which they are).. They are overworked and running around in circles because they choose (via their unions which they control) to delay or refuse to implement required changes and continue to embrace restrictive work practices, work demarcation and overstaffing. Rielly can suggest all he wants (and while I am not a fan of his), it has not been his fault that the HSE have continued to fall well short of changes required (as they did with previous ministers and experts). You could swap Rielly out tomorrow and put in anyone, and you will continue to see exactly the same reaction until staff within the HSE en masse decide to start driving change through the organisation.0 -
Well Yes, Yes and Maybe but not exactly (we are getting closer)
I agree with you up to here, but I would slightly argue that its also the HSE's job to identify and implement change.. If we need Rielly to tell them not to make and deliver dinners to patients that are not in the hospital etc. then the whole staff chain needs to be replaced.
Agreed, we don't need Dr Reilly or his replacement (as now looks more likely with all the current private distractions) to get involved with the tactical side of service delivery. I believe the problem lies more on the strategic side of focusing on the goal of improved customer care with less money and bringing unions and staff along on the journey to achieve that goal. That's the leader's job, not getting bogged down in detail.And this is where I was trying to highlight the issue in Ireland that everyone seems to prefer to throw the glaze upwards and blame senior staff (Rielly, Consultants etc.) and tell us how overworked many of the HSE staff are (which they are).. They are overworked and running around in circles because they choose (via their unions which they control) to delay or refuse to implement required changes and continue to embrace restrictive work practices, work demarcation and overstaffing. Rielly can suggest all he wants (and while I am not a fan of his), it has not been his fault that the HSE have continued to fall well short of changes required (as they did with previous ministers and experts). You could swap Rielly out tomorrow and put in anyone, and you will continue to see exactly the same reaction until staff within the HSE staff en masse decide to start driving change through the organisation.
I don't just prefer to "throw the glaze upwards and blame senior staff". All I'm saying is that leadership and management has to start at the top. Dr. Reilly's performance up to now is showing little evidence of progress in giving us all the health service we want and that he signed up to deliver.
As regards swapping the minister for someone else ..... isn't that what a lot of people said in the months before Chamberlain was replaced by Churchill in 1940. Nobody would claim that Churchill alone won the war, but he did initiate the changes necessary to enable his people to produce victories, starting with the Battle of Britain, leading to El Alamein 29 months later and, finally VE Day in 1945 (with lots of external help from the Yanks).
The point is he initiated the changes ........ The Minister for Health, regardless of who this is, has to do likewise.:)0 -
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That is simply not going to happen.
Even if you did have a proper independent, complete, thorough, root and branch examination of the entire HSE it would not be possible to implement the vast majority of its likely recommendations.
Anyone identified as surplus would have to stay because that is the way it is.
If pay adjustments up and down for various staff were recommended only the pay increases could be implemented because that is the way it is.
If wholesale changes to work practices were suggested these would most likely not happen or would do so at a snails pace because if staff and the unions object then there is no effective sanction to force implementation.
Those are the things that any other organisation would do if faced with a similar crisis because it would have to. Indeed many organisations do this routinely even when not in crisis because layers of fat grow and wasteful and inefficient practices appear in most organisations over time.
But of course the HSE does not really have to do any of this.
Of course it could be done if there was political will but there is not and the will not be. We will carry on as we are.
I see the troika have focused in on the HSE overspend and have requested that it is sorted by their next review.
What will we do? Take proper reform seriously? I think not.
What chance another untargeted round of early retirements just to destroy services a little bit more and trumpet more payroll savings.
Again, most will agree with you.. and in fairness to Dannyboy83 he has stated the same as you have.. "experience shows that it won't happen." It's me being the arguementative git
Regarding the bolded statement above. Policital will generally reflects the will of politicians to survive. If the people of this country made political re-election dependant on the reforms required, it would happen. While we put more political will on local pot holes and local treats then thats where the priorities will be placed. Thats why I continue to have little sympathy for people who abuse or who work within and fall foul of these process.0 -
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