1. St Luke’s Symposium November 2010 Leading Change Cathal Magee Chief Executive Officer Health Service Executive St Luke’s Symposium Novmber 2010 St Luke’s Symposium November 2010

2. Leading Change where are we? where are we going? how do we get there? plans/projects/resources/implementation St Luke’s Symposium November 2010

3. Context: Economic health is 27% of State spending borrowing €5bn/€6bn p.a. to fund healthcare our annual budget deficit is €19bn annual borrowing is 12% of GDP - capital markets and EU require 3% by 2014 funding outlook is very challenging opportunity to build sustainability St Luke’s Symposium November 2010

4. Context: Healthcare Trends rapidly ageing population adults with chronic conditions up 40% by 2020 number of cancer cases to increase (CAGR +3%) incumbent models of care struggling to keep up time for change St Luke’s Symposium November 2010

5. Context: Public Perception public are losing confidence and patience ‘Irish citizens are divided in their perceptions of the quality of healthcare, 33% rate the quality as ‘fairly good’, 5% rate the quality as ‘very good’ while 40% rate the quality as ‘poor’ ’ Key findings from Accenture Institute for Health and Public Service Value Study 2010 St Luke’s Symposium November 2010

6. HSE Healthcare Vision Is consistent with international trends – integration of primary and secondary care – centres with scale & specialisation – quality & safety with transparency in outcomes – care pathways and standards (clinical programmes) – clinical engagement & leadership St Luke’s Symposium November 2010

7. How do we get there? clear rationale for change widely shared with key stakeholders educate the public and the patient investment required to build and develop - leadership & governance - information technology - organisation that can deliver safe, quality healthcare

8. St Luke’s Symposium November 2010 Challenges legacy structures culture and behaviours resistance to change operating model too centralised management bandwidth & accountability governance and management process St Luke’s Symposium November 2010

9. People commitment of people in the health service must value people’s work & contribution protect relationships we have built change without trust ‘almost impossible’ focus on patient care aware morale is a problem nchd shortage indicates issues need to be addressed

10. St Luke’s Symposium November 2010 Unlocking High Performance in Healthcare ‘ the leadership needed to transform the performance of hospitals and health systems must come principally from doctors and other clinicians whether or not they play formal management roles’ - McKinsey St Luke’s Symposium November 2010

11. Clinical Directors need strong & effective clinical leaders critical part of leadership of health service role needs to be supported and developed support clinicians in their responsibility to lead change critical role in resource allocation & decisions setting this as a high priority St Luke’s Symposium November 2010

12. Clinical Programmes innovative and forward looking initiative provides framework and a blueprint addresses quality, access and cost college’s role is critical – joint programmes national strategy/local ownership engaging clinicians at large in driving change challenge is implementation St Luke’s Symposium November 2010

13. S pecialist Training our ability to provide high quality service inextricably linked to quality of training we must work together to attract, develop and retain the highest quality nchds strategic importance to colleges and to nchds HSE committed to facilitating and supporting St Luke’s Symposium November 2010

14. Role of Colleges and Forum collaborative approach with postgraduate colleges provides for a professional voice – standards provides leadership to profession means by which HSE can engage with clinicians on a professional, collective basis recognise significant progress to date St Luke’s Symposium November 2010

15. have to be honest and realistic economic climate challenging political and public environment regulatory environment – more demanding no quick fix motivation has to be about patient care Realistic Expectations

16. St Luke’s Symposium November 2010 continue to work with the forum & college – clinical directors – national clinical programme – specialist training leverage the networks and leadership clinical programme implementation – prioritisation, – planning – execution change is possible Looking to Future