Slash and Burn in the HSE

There’s been comment in the news about the HSE actions to deal with a deficit to date of €140 million on it’s €14 billion budget. There’s been criticism of the actions being taken which include amongst others a ban on the recruitment of frontline staff i.e. staff who provide direct services to patients.

The bulk of the HSE budget is payroll costs, so I can understand why payroll costs are being tackled. Yet, one of the demoralising aspects of working in the HSE is the length of time it takes to recruit- up to two years in some cases. In May 2007 the manager of Cork University hospital wrote to the HSE saying they could not be held liable for the medical consequences of delays in filling crucial replacement posts.
It appears both HSE headquarters Finance and HR senior management do not appreciate the impact of this type of crude decision making.

I was speaking to a senior professional in a health care provider recently. He went to a special meeting to discuss this issue and he stated he could literally feel the increased stress and tension amongst staff as he walked through the building.
At one stage in this professional career, was the CEO of a major commercial organisation, so this guy knows all about targets and has a tough no nonsense approach. But as he says “how do you tell staff, Johnny can’t be replaced because of the recruitment ban and then expect them to deal with the ever increasing number of patients?

Often organisations have to take action to stay within budget targets. It’s a key responsibility of management. As an old boss of mine used to say though you had to do it “without doing violence to the future, slash and burn not allowed”. In other words, short term action now must not harm the future growth of the organisation. With unions threatening industrial action, confidence in the HSE is being further undermined by the ban on recruitment.

So as a manager what type of action should you take when you’re in a budget overrun situation?
First of all, identify what the Management guru’s call the “low hanging fruit or quick hits”. These are actions you can take quickly with impact in the short time and don’t do “violence to the future”

For example, HSE management could immediately reduce the temperature of hot water in their centres. I’ve been in three different hospitals recently (as a visitor thankfully) and in each hospital the temperature of the hot water for washing hands was close to scalding. Reducing temperature by 10F can give a 5% reduction in energy costs.
Other simple easy to take actions, include faxing instead of posting, telephone or video conferencing instead of travel to meetings. Every organisation(except possibly Ryanair who are notorious for their focus on costs ) will have short term opportunities to reduce costs without damaging customer or patient service.

Secondly, identify actions that may take longer to implement but will also reduce costs whilst improving service to customers. Sounds like a contradiction, does n’t it? But this is always possible.
For example in the BBC series “Can Gerry Robinson fix the NHS”most doctors were removing eye cataracts as a day case operation with a local anaesthetic. However one doctor was still doing cataracts under general anaesthetic, which not only uses more resources but also has increased risks for the patient.
By supporting this doctor to move to day case procedures, patient service would improve and costs would be reduced.

I don’t think any one would question that our health services have hugely increased resources at their disposal and that there is substantial waste and inefficiency.
HSE management in local centres need to take a lead on cost reduction. They should involve staff in cost reduction on the basis of reducing costs to improve service.
Creative thinking tools like De Bono’s six thinking hats can help generate ideas.
I can’t find the reference but I recall one De Bono project in an American public sector organisation where staff were allowed to take lucrative redundancy packages, if they eliminated the need for their job without adversely impacting customer service. Nearly 40% of staff were able to come up with qualifying ideas!

If such an approach was adopted in the HSE with it’s highly trained staff, the outcomes could be amazing.
This type of approach does require leadership and trust. It requires an ability to think creatively and laterally and questioning of all “sacred cow” assumptions. All qualities that successful high performing managers have developed.

So, rather than simply rely on ever increasing budgets,and blaming the “top HQ” . Local managers need to be proactive and take action to ensure budgets are used more effectively. National HSE management need to further develop budget structures which ensures local centres are rewarded and not penalised for more effective use of budgets.



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