‘Management class’ in health service is distracting from delivery of care to patients

By dara
Thursday, 26th January 2023
Filed under: News, PressReleases, 2023

Leading Professor at University of Limerick says health service has “taken eye off the ball”

  • Prof Orla Muldoon CCW imageProfessor Orla Muldoon says emphasis on performance indicators and lack of focus on expanding frontline hospital capacity and resources to care for patients is creating a ‘management class’ in the health service and detracting from treating patients
  • Current corporate management structures a source of frustration for medical professionals who are “not trusted to manage the system”
  • Meanwhile, almost 8 in every 10 Consultants screening positive for burnout as many medical and surgical specialists continue to move abroad to other health services
  • 870,000 people were on some form of hospital waiting list at the end of November, including almost 97,000 children
  • Prof Muldoon: “A vast amount of effort is put into counting Key Performance Indicators. KPIs in the private sector come with the resources to achieve them; when imposed on the public health service, there are no extra resources to deliver the care.”

A leading Professor at the University of Limerick has said that the continued trend towards imposing a corporate model in our public health system is compounding the service’s inability to deliver care to patients.

Speaking in a New Video as part of the Irish Hospital Consultants Association’s (IHCA) Care Can’t Wait campaign, Prof Orla Muldoon says too much emphasis is being placed on Key Performance Indicators (KPIs) and not enough on providing the capacity and resources required for treating patients.

Management class
The Professor of Psychology explains how this in turn has created a ‘management class’ in the public health service of which many decision-makers are not medical professionals. 

She questions why the medical and surgical specialists and leaders in hospitals are not “trusted to manage the system” or the people they care for on a daily basis. 

Commenting, she said: “We have this paradox where patients, once they get into the system, feel the quality of care is good. Yet, we don’t really believe the people providing that care can take leadership roles in the delivery of the service.”

The IHCA has frequently pointed to consistent failures to deliver on plans, funding and Ministerial promises as being indicative of a waning motivation to fix the problems in the health service, at a time when significant effort is needed to implement practical and sustainable solutions. They say this is leading to the continued exodus of medical and surgical talent abroad, to better working conditions and services.

Recent studies show almost 8 in every 10 Consultants are screening positive for burnout as they struggle to cope in an overstretched public hospital system where demand has outstripped supply.

Prof Muldoon says that this is the case across the entire health system as “those who we have tasked with caring for our most vulnerable” increasingly describe the management structure and use of performance indicators as “frustrating”. 

Focus on delivery of care
Prof Muldoon says this also shows that far too much focus is being placed on counting performance indicators rather than on providing the capacity and resources for the delivery of essential services to patients.

“This model of using KPIs to identify areas of improvement works in the private, corporate sector, because those entities are given all sorts of resources to help achieve their targets. But in the public health system you have more people counting performance indicators, but no extra resources allocated to the actual care.”

The IHCA have previously stated that a laser like focus is needed to deliver the two vital resources every patient needs – hospital beds and hospital Consultants.

The Association says 5,000 hospital beds are needed by 2030 to meet current and expected demand, given 870,000 people are currently waiting to be assessed or treated by a hospital Consultant including almost 97,000 children. 

Healthcare reform
Prof Muldoon believes that the Government has taken their “eye off the ball” when it comes to the management structure within our health service.

In the 10 years since the introduction of Consultant pay inequity, Outpatient waiting lists have surged by 200,000 (52%) and Inpatient/Day Case waiting lists have increased by 29,800 (58%). While there has been a more than a 300-fold increase in patients waiting longer than a year for hospital treatment1.

The IHCA echo Prof Muldoon’s sentiment that reform is necessary and are urging the Government to focus on practical solutions to fill the 918 vacant Consultant posts on a permanent basis and increase the number of Consultants to at least the EU average. This is vital if the record hospital waiting lists are to be addressed. 

To achieve that, the Government must reach an agreement with the Association on a new Consultant contract that is attractive for our existing Consultants, our Consultants in training and the new medical talent that are needed to be attracted into permanent posts. 


1.    Latest NTFP data as at end December 2022:  https://www.ntpf.ie/home/nwld.htm; HSE December 2012 Performance and Supplementary Reports: https://bit.ly/HSEReportsDec2012

Professor Orla Muldoon is a Professor of Psychology at the University of Limerick and a member of the Irish Research Council. Her comments were made in a new video released on social media today by the IHCA as part of its #carecantwait campaign. 

The video is available here: https://vimeo.com/771624515

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