‘Is someone going to saw off the plank behind me?’ – Healthcare managers priorities, challenges and expectations for service delivery and transformation during economic crisis

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 European countries [2]. This impact, although rooted from 2008 when Ireland reached fiscal crisis point, became clearly apparent in 2012 when indicators of health resourcing and performance showed the health system doing ‘less with less’[3]. Since 2008 health funding was cut by €1.7bn and 12,000 whole time equivalent positions were taken out of the health service. 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. ‘Is someone going to saw off the plank behind me?’ – Healthcare managers priorities, challenges and expectations for service delivery and transformation during economic crisis