Sunday, July 12, 2009

"Beginning to Engage"- The complacency of the mediocre.

My family have had a long dark fortnight. We knew it was coming and the outcome thank God has been a good one but an emotional numbness remains. Now that James is home from Crumlin we can sleep in our own beds, pay attention to our other children, nurse him in the comfort of our own home and gain relief from knowing that his surgery has been a succcess, a hurdle has been crossed, the spectre of fear of tragedy has passed. But it is hard to write about, and speak about, and the experience is still chest-tightening to think about, and doesnt yet feel much like relief. When JK Rowling conceived the spectre of the Dementors in her Harry Potter Saga she could have drawn on the living grief and the empty fear of parents of desperately -ill children. Parents who have no power but to hope, who are often too angry to pray. To parent a child through pain you cant control or through awful invasive heart surgery in which you must have faith is to be touched by a Dementor, to inhale the stress, to be drained flat and cold. You inhale all that into your chest and then take another deep breath to find the strength to be a parent, to make your child trust, believe and heal.
Just after James surgery when he was still in intensive care I answered an invitation from Kildare Souths conscientious TD Sean OFearghail to attend his committees grilling of Professor Drumm of the HSE. The timing was bad but I went to try to get a flavour of this man presiding over the vast and inert human pyramid we call a health service. The committee itself had called this man to make sense of why, without any political compunction, Crumlin hospital had cut back essential services, closed operating theatres, and launched a war of words with Drumm at the first hint of coercion to reduce costs. The background story we have all heard is of a 9m euro deficit which the HSE has forced Crumlin to live with in 2009. The real story however, according to Drumm, is that Crumlin over-spent by 9m in 2008 and have simply been told by the HSE not to do so in 2009 as this year "we wont have the 9million to give you". Now even to me as a parent that sounded reasonable if indeed the money wasnt all wisely spent or if good efficiencies could be found without care being compromised. OFearghail himself put it succinctly and fairly " We are asking the hospital managers to manage this hospital and find efficiencies without sacrificing front line services". OFearghail is one of the good guys. I am in agreement with him in putting it up to managers to fulfill their job descriptions and manage costs- including their own cost.
Drumm made three good points that the entire panel of cross party TDs found agreement with; He wanted Crumlin to pool their blood costs and needs with St James'; He wanted them to raise an extra 12million a year by billing their private patients more accurately; He wanted them to cut their payroll by 3% as they pay the highest rate and proportion of over-time of any hospital.
These three requests the board of Crumlin have failed to do but have cynically reacted in a war of PR with the HSE by closing a theatre and wards. On these three simple cost efficiencies Drumm is right and the board of Crumlin plainly are remiss in a city full of hospitals and full of wateful duplication of service in some areas ( for example we have 3 childrens A and E in one city ) and only 80% use of beds in some parts of Crumlin while children from Temple street hospital wait often in over-crowded adult wards.
But there are disturbing mediocrities emerging about Drumms role also; Questioned at length by OFearghail and his committee about who calls the shots-or are the HSE just observers ?.. Drumm procrastinated, prevaricated, " Crumlin havent agreed how to cut the costs" ..." I have asked Crumlin for full support for a Cross-clinic approach"..." Paediatrics needs a leader as oncology has made great strides with its new clinical leader"... On more than one occasion in the debate Drumm acknowledged difficulties in getting the hospital board to his view point but used the phrase" we are beginning to engage". How many years into Drumms job has it taken him to get the hospital boards to begin to engage...
TDs challenged Drumm about a credibility gap between what Crumlin had told O Fearghail,s committee and what Drumm was saying. He did acknowledge this credibility gap and explained the difficulties in terms that would be clear to students of organisational behaviour in any business school; Drumms hands are tied by human resource management issues, by resistance to change, by his failure to acheive involvement in his vision for the future of health care.
The answers to me are not crystal clear or neatly aligned into a strategic change management ladder towards a wonderful dynamic future for our HSE. But there are some things clear to me- Drumm is a poor communicator and lacks the courage to execute real change.
His vision - and it is also Harneys vision- is the wrong one, as why otherwise would opposition to it be so intense and widespread. His exasperation with the unions, the work practices of hospitals, his veiled criticism of boards he is only now beginning to engage with; these are the flaws of a man who is not a leader or a lateral thinker, who should be still treating patients- not trying to focus a big picture which to him plainly still remains a jigsaw in pieces.
To put one final fact to the philosophy, to put this in context. Crumlins wage bill is 74 % of its entire budget. I dont know of one business sector that could be viable with that cost ratio for labour. Childrens health care doesnt need to be compromised. Does this issue like so many others arrive back at the need for unions, for people, to be realistic about how money should be spent and what the rest of us are able to pay for.

No comments:

Post a Comment