Sir, – Minister for Health Stephen Donnelly is correct in pointing out recently that a fundamental requirement for a healthcare system, as with any other business, is a performance measurement and performance management system. Establishing a performance system is thankfully now a priority for the Minister. Without such a system, extra money invested in healthcare reform can be largely wasted.
It is, however, incorrect to suggest that this type of operational information has not previously been available. Between 2005 and 2010 when the HSE was being established, a performance measurement system more comprehensive in its scope than most other systems worldwide, with an aligned performance management system, was implemented. It was called HealthStat and its structure and operation have been widely documented .
The performance measures ranged from waiting times for clinic appointments, diagnostic tests and planned procedures to the length of stay for patients undergoing specific treatments, to the use of resources such as staff numbers, absenteeism, adherence to budgetary targets, etc. The performance figures for hospital and community-based services were made available online and open to public scrutiny.
Monthly forum meetings took place with the clinical directors and management teams responsible for service delivery in individual areas to identify good and problematic levels of performance, with the focus on using good performance to inform improvements in processes in areas where performance was weak. This was the first time healthcare professionals became aware of how they were performing in relation to their peers using common metrics. Initially the process created a certain amount of unease because of the level of public scrutiny but the benefits were quickly embraced by most participants when it was clear that the data was enabling significant improvements in the quality of services within the funding available.
The Minister can take encouragement for his approach from the fact that the HSE during those years was, as confirmed by the reports of the Comptroller and Auditor General, consistently within budget, despite major cutbacks in funding during the financial crash in 2008, 2009 and 2010. There was also a progressive reduction in waiting times for elective procedures during this period, with waiting times in 2009, despite the crisis-induced reduction in funding, being markedly lower than they have been at any subsequent time. The government in 2012 made a decision to disband the HealthStat system. It has to be assumed that the level of transparency the system provided was unacceptable. This decision effectively left the largest business in the country operating without a performance management system. Hopefully all stakeholders will support the Minister in his determination that performance data is required to justify investment. While, after a 10-year gap, it will take time to re-establish a system as comprehensive as HealthStat, doing so is an essential prerequisite for change and improvement. – Yours, etc,
Prof BRENDAN
DRUMM, MD
(Former CEO
of HSE, 2005-2010),
Dublin 6.