Overview

1. Social Partnership, Participative Governanceand Systems TransformationFindings from an empirical investigation in the Irish Health Care SectorSocial Partnership, Participative Governanceand Systems TransformationFindings from an empirical investigation in the Irish Health Care Sector

2. Overview • Project Background • Context of the project: research questions • The wider context: industrial relations, public finances and health care transformation in Ireland • Research Approach • Research Findings • Project Outcomes • Developing agreed recommendations • Enhancing the industrial relations context • Implementing the recommendations

3. Background • Research Questions Given the clear performance differential between our acute hospitals… • What is the empirical evidence regarding the impact of workplace practices, management systems and governance on performance levels? • What can we learn from high performing hospitals to improve quality and safety of patient care, hospital efficiency, and staff outcomes? • What implications does this evidence have for management (administrative and clinical), front-line staff and trade union representatives? • What implications does this have for government and the social partners?

4. Background (continued) • The Wider Context • Transforming public services agenda, including health care transformation • Growing demand on services • Greater regulation and performance monitoring • Declining resources • Organisational reconfiguration • Need for significant flexibilities from workforce • Ireland’s social partnership system • Industrial Relations and Partnership in the health sector

5. Background (continued) • 2008 – dramatic deterioration in the Irish economy • 2009 – Government faced with stark choices to contain the serious crisis in the public finances (Current spending projections 2010 €52 billion, exchequer income €34 billion) • Budget 2009 – crisis for social partnership and public sector unions. Crisis within a crisis for health sector unions and employers. • So near… but too far?

6. Research Approach • A collaborative approach in a highly-fragmented health sector • Health Services National Partnership Forum – employers and trade unions • National Centre for Partnership and Performance – government departments, social partners

7. Research Approach (continued) • Three primary evidence sources: • Existing quantitative data • performance data from Health Service Executive • quality data from Health Information and Quality Authority • Original quantitative data • survey of key personnel in the acute hospitals • Original qualitative data • Site visits with detailed interviews & focus groups with cross-section of staff

8. Existing quantitative data

9. Survey and Site Visits • Largest survey ever undertaken of workplace practices and management systems in the acute hospital system in Ireland • Focus on systems, practices and real-life experiences of direct staff involvement and union involvement in planning and implementing change and innovation • Direct staff involvement in service improvement • Collaboration and team working • Shared governance • Strategic HRM • Partnership

10. Overview of Findings • Extensive empirical evidence of variability in governance and management systems between hospitals • Extensive empirical evidence of variability in management practices within hospitals

11. Findings (continued) • Evidence of statistically significant correlations between governance / management systems and key performance outcomes including: • Absenteeism levels • Hospital performance (Day Case rates, OPD performance, etc.) • Hygiene standards

12. Findings (continued) • Hospitals with sub-standard hygiene services also had a poor approach to involving their staff in managing continuous quality and risk improvement • Hospitals with higher levels of shared governance had lower levels of sickness absence among nurses • Hospitals with poorer systems for staff involvement in quality and risk improvement also have significantly lower day case rates. • Hospitals with better systems and practices for involving patients in the design and improvement of hygiene services also had significantly better day case rates.

13. Findings (continued)

14. Hospital Hygiene Standards

15. Findings (continued) • Hospitals with lower in-patient cancellation rates had: • better systems and practices for staff involvement in continuous improvement • better systems and practices for involving patients • More involvement of frontline staff in service improvement

16. New:Return Ratio x Partnership Practices

17. New:Return Ratio x Collaboration and Teamworking

18. Missed Appointments in OPD x Direct Staff Involvement in Service Improvement

19. Voluntary Turnover among Nursing Staff x Partnership Practices

20. Voluntary Turnover among Health and Social Care Staff x Involvement in Continuous Improvement

21. Conclusions • Participative Governance and Management Systems: • Direct staff engagement / involvement and representative involvement (partnership) need to be seen as two sides of the same coin, mutually supporting each other • Unions and employers need new model of staff engagement for participative approach continuous improvement and innovation

22. Recommendations • Transforming the wider policy framework • New model of partnership and participative governance • Networked Innovation model • Institutional Capacity

23. Where to from here? • December 2009 (pre-budget discussions) – draft agreement negotiated, Government decided against the deal, imposition of pay cuts across public service, unprecedented collapse of social partnership • December 2010 – April 2010 – escalation of industrial action, deterioration of relationships, polarisation of rhetoric • April 2010 – New agreement for public sector transformation negotiated • Guarantee of no further pay cuts until 2014 • Improved security (short-term) for pensions • Possibility of recouping imposed pay cuts in following change of economic circumstances • Commitment by unions to widescale transformation of the public service, including ambitious agenda in health sector

24. Health Sector Transformation • Key Components of Health Sector agreement • Redeployment of staff • Extended working day • Integration of primary, community and acute care systems • Multi-disciplinary working and intra-professional governance • Cost containment through partnership • Continuous improvement of cost & quality through evidence-based performance measurement • Strategic Engagement and Innovation initiative – to provide the context for national level and local level engagement between unions, management and staff, for rebuilding trust, and dealing with the issues. • May 2010 – Public Sector trade unions voting on the deal