HSE - Public Health East - Reorganisation Mobilisation

Health Service Executive (HSE) 

Public Health Reorganisation

BACKGROUND

In June 2020, when the COVID-19 pandemic was in full flow, the Health Service Executive (HSE) decided to mobilise a multi-disciplinary team for HSE East (the Greater Dublin area). It was an idea that had been under consideration for some time, and the conditions created by the pandemic crisis accelerated the necessity. The region was split into three areas, with a multi-disciplinary team established in each one. The teams sprang into action, but the circumstances were difficult, and there was clearly room for improvement.

CHALLENGES & OPPORTUNITIES 

Since the outset of the pandemic, VISION Consulting (VISION) had been in situ at the HSE helping it to navigate through the multiple challenges presented in their response to COVID-19.

VISION were therefore well placed to help with the multi-disciplinary project and were asked to step in with a pilot project to improve the performance of one of the three teams, CH07. This community health team covered consultants, specialists, doctors, nurses etc. coming together to replace a traditional ‘command and control’ structure with a more lateral approach that gives individuals greater responsibility.

VISIONs task was to help the team overcome the many challenges they were experiencing, exacerbated by working in the circumstances of the pandemic crisis. These included confusion over responsibility and reporting, and individuals trying to do everything rather than focusing on their specific roles within the multi-disciplinary team.

VISION were working with highly talented and committed medical professionals operating under difficult conditions. Many of them had natural talents as leaders and managers, but these weren’t skills that they had been trained in or ever had much time to focus on. 

VISIONs challenge was to give them the guidance that would help them all work together far more effectively to improve the quality and safety of the public health response to COVID-19.

CONTRACT MANAGEMENT

VISION APPROACH

VISION approach was to put in place the steps to deliver an effective operational practice by week four, and one that would be working really well by week six. 

VISION firstly examined existing meeting habits and put in place the operational practices to deliver these specific outcomes: 

• Team members to have clear ownership of their work.

• Specialists to delegate appropriate functions to other clinicians in the team (giving them opportunities to grow). 

• Specialists to work to the top of their licence and, as a consequence, focus on the important elements of their skillset. 

SERVICE DELIVERY

The implementation took place over three phases and two time periods across 2020 and 2021:

1 Actions for improving the CH07 team

VISION carried out an immediate diagnosis and identified the key challenges as a lack of clarity over individual roles, and confused lines of communication and reporting which, in turn, were contributing to further miscommunication and distrust. 

VISION then designed a solution founded on Commitment-based Management (CbM) to bring new distinctions and develop capabilities around building trust, recognising and shifting moods and moving to action fast. 

These included practices such as daily huddles, coaching of individuals and teams, introducing an understanding of trust and moods, and regular operational practices and reviews.

2 Coming to agreement on the new organisational design

VISION led on this transition with a central focus on facilitating discussions, resulting in collaborative agreement with the three new Directors of Public Health East (DPHs) and other key stakeholders on the new governance structures, plus the positioning of central functions and the allocation of resources, and the agreement on the required priority processes to continue or to be amended.

Following these structured planning sessions, VISION produced a draft Change Management Plan that showed how to successfully implement the reconfiguration in the first three months of 2021.

3 Communication and consultation of draft Change Management Plan

Following sign-off of the draft change management plan, VISION drafted a communication for the three DPHs to be issued to the DPH East staff around the change management transition agreements. This included visuals of agreed governance and reporting lines, and immediate implementation plan and priority steps to be progressed. VISION then set up and facilitated workshops with workstream leads and the three new DPHs to discuss new reporting and governance lines and priority areas to be progressed over the following six to 12 months.

CONTRACT PERFORMANCE 

OUTCOMES 

After completion of the initial six-week phase, the team was working in a much more effective and coordinated way, which led to the more efficient use of limited resources. This had a positive effect on how the team in Public Health East were able to manage the response to the COVID-19 pandemic. 

A further benefit of this increased efficiency and effectiveness was the implementation of a clear clinical governance structure by the team, within their team and aligned to the Department of Public Health East. 

VISION then went on to achieve the following:

• Agreement with all parties on the new organisational design.

• Governance agreed.

• Use of split resources agreed by three new directors.

• Change Management Plan produced and signed off, and communications to all PH East staff.

• Implementation plan agreed and communicated to all stakeholders.

Facilitated workshops with all stakeholders around implementation plans and initial steps.