The RCSI and its chief executive keep a low profile. But there is no disguising the success of what has been labelled “an entrepreneurial rapid-response unit worth €500 million”
Michael Horgan is stepping down as chief executive of the Royal College of Surgeons in Ireland. To most readers, the news in that sentence is the fact that he stepped up in the first place. Michael Horgan has been a low-profile leader of a low-profile institution.
The story of Michael Horgan is yoked to the story of the college over the past 30 years, although he has only been chief executive for five. RCSI is an outlier in Irish higher education – an entrepreneurial rapid-response unit worth €500 million. It is fully self-financing, with the exception of one in five of its students, who will enjoy the national free-fee scheme for as long as it lasts.
The other 80 per cent are from outside the EU and bring €45 million in fees to the college every year. The rest of the wealth has accrued through canny investments at home and overseas: hospitals; training centres; research units; and valuable real estate from Beaux Lane to Bahrain.
But it was not always like this. When Michael Horgan joined the college in 1974, neither he nor his employer were top of their game. Horgan joined as an admin man in a mid-level role. The college, which had been in operation since 1784, was cruising slowly towards penury. The old med schools regarded the college as a poor relation.
“For a period it was thought that standards at the RCSI were not as high as elsewhere, that the admissions policies were too lax, that the teaching talents did not match the sector generally,” says one medical academic. Add to this a growing awareness that fees alone would not sustain the college into the 21st century, and the RCSI was at its lowest ebb in 200 years.
As Horgan worked his way up the ranks, from superintendent of schools to IT director to HR supervisor, he became increasingly involved in the strategic operations of the college. He worked at night to build up his academic qualifications, including a master’s degree in industrial engineering. The closer Horgan got to the boardroom, the more astute the college strategy became.
“Long before taking up the CEO position, Horgan had a huge influence on strategic direction at the college,” says an insider. “He was part of the team that bought properties around Stephen’s Green to ballast income. It was his idea, in the early 1990s, to equip every student in the college with a personal laptop – unheard of at the time. He developed the BeST programme, an online surgical education delivery model. He conceived and realised the notion of a mobile surgical training unit that could travel to hospitals and train staff on site.”
Thanks to these and other innovations, the RCSI is now at the forefront of the development of medical education, says one medic. But Horgan is not a medic. This may go some way to explaining why he has stayed out of the public eye, says a colleague.
“Michael prefers to let the surgeons do the talking,” says a university figure. “He doesn’t push himself or his college into the limelight. He has no high-flown titles so he lets the medics go out front, but he makes everything tick. He is the beating heart of the organisation.”
Conversely, Horgan is celebrated overseas. In 2004 he was awarded the First Order of Bahrain for establishing the Medical University of Bahrain, a fully owned constituent university of RCSI. He has a considerable profile in the Middle East and his work there has value beyond the medical sector.
“Michael is a magnificent ambassador for Ireland,” says a collaborator. “It’s a joy to behold him moving with ease among sheiks and other dignitaries. He has genuine charm and a wonderful strategic brain.” RCSI enjoys close links with Enterprise Ireland: the agency awarded the college €2.3m in research funding last year. It is said that Horgan’s relationships in the Middle East have opened trade doors for the State.
Horgan’s commitment has taken him far beyond the Middle East. RCSI and UCD have established Penang Medical College in Malaysia, where Michael lived for many months laying groundwork and building contacts. “He has persuaded many others in the medical community to get involved in the region,” says a UCD academic. Horgan has also made inroads into Africa, where the college is involved in the development of a regional network of independent medical education centres free from political constraints. The project is drawing in a wide partnership of participants and is designed to develop Africa’s health infrastructure.
Back at home, the RCSI is unrecognisable from the institution Horgan joined in 1976.
“The RCSI is now the only higher education institution in the country that parallels the great private US universities,” says an educational leader. “Only 8 per cent of teaching and learning support comes from the State. It can only survive by offering its product on international markets. The college has learned to stand on its own two feet. It sees its survival as its own business.”
The transformation has drawn criticism. “There can be a difficulty understanding the financial model of the college,” says an observer. “This has led to some resentment and envy. Some State agencies have difficulty with it too. They try to simplify administration and structures to a one–size-fits-all model. RCSI doesn’t fit the model.”
Because the RCSI is a not-for-profit body, all surplus earnings are invested into capital projects for the institution or investments to safeguard the college’s financial security. RCSI spends a lot of money on property. With its valuable site on York Street, Beaux Lane House, an Education Research Centre in Beaumont, a research centre in Blanchardstown and another in Waterford Regional Hospital, the physical spread of the college may be seen by some as rapacious. It’s Horgan’s style to grab while the grabbing’s good.
“The week that the Luas line was opened, he decided to spend lunchtime travelling the new route,” says a colleague. “When he returned, he had a number for an estate agent selling an office block at the Sandyford station. It’s only 20 minutes door to door! Let’s buy it!’ he said. That’s now our graduate entry programme centre. That’s how he operates.”
It’s easy for the RCSI to act quickly. Unlike the other medical training institutions, it is not a prisoner of public policy. However, Horgan has never had an appetite for provocation. “Michael won’t rock the boat – he wants a constructive relationship with the Government,” says a stakeholder in education policy. “The RCSI values its Irish identity. It does not want to be seen as an offshore medical school.” To strengthen those roots, the college is involved in a number of local philanthropic activities, such as outreach to secondary schools, public health education and Traveller access.
However, as a pet partner of Enterprise Ireland, the national value of the college has not gone unnoticed.
“If you look at it as a business, the RCSI employs 800 people, 80 per cent of whom are graduates. Add to that the €20 million a year that its overseas students spend over and above fees. It’s heavily involved in research with potential to feed back into the commercial biomedical sector here. It’s the perfect model of a high-knowledge, large-scale indigenous enterprise.”
Horgan, who is largely credited with this transformation, is stepping down shortly and the search for his replacement is already underway. Still in his early 50s, he is likely to remain active in strategy, although his next station is unknown.
Born in Cork in 1957 and educated in the North Monastery, Horgan started out his career working in the IPA and ANCO. He is a keen golfer and a deeply religious man, “with an unerring capacity to find a Catholic Church in the least likely of places”, according to a friend. He will doubtless retain his global connections and continue to represent Ireland around the world.
“The immensity of Michael’s contribution won’t be realised for some years,” says a leading medical academic. “Ireland should be proud of Michael and his achievements.”
