Dateline: Lahinch, County Clare, Ireland
I’m sitting over the seawall and embankments of this seaside town in the west of Ireland, watching the Atlantic waves crash and dribble onto the shingle in what must be their most peaceful mood on a surprisingly warm April evening. I’ve been talking to a friend, a retired Irish nurse, trained in London, who spent her career working mostly in the United States. Many of her relatives are doctors. Of the Irish healthcare system, she says, “I don’t understand it. Nursing I understand, but not the system here.”
I’ve just come from Dublin, where I addressed the second annual Master Class of the Irish Health Services Executive, bringing together executives, managers, and practitioners from across the whole national system. Irish healthcare has enormous weaknesses, not least of which is that when the “Celtic Tiger” era collapsed in turmoil in 2009, their funding, already low by percentage of GDP and constant dollars, took a 22% cut almost overnight — and the cuts came across the board, rather than managed to target true waste or create new efficiencies. But it also has its great strengths, not least of which is the willingness to convene conferences such as this one, drawing top people from across the sector to ask the big questions: How can we do this better? How can we create more resources within the system by becoming lean and smart?
My discussions with officials in the counting houses of the Irish government, with clinicians, with entrepreneurs and major employers, with average Irish citizens over the last month had a fairly consistent theme: We used to pour money into healthcare. It leaped up year after year. Then the crash and slash came, and since then funding has been flat for six years. Now for the first time we have put some more money back into healthcare — but we want to see results. We don’t want you just to increase salaries that were cut. We want to see fewer people on gurneys on hospital hallways. We want shorter wait times to have a surgery or see a specialist. We want palpable improvements.
Though the situation may seem quite different from the American experience (vast overspending, budgets the size of planets), that challenge — how to wring more real value from the dollars and euros spent — is exactly the same.
The top presenters and the discussions centered around them all wrestled with the question — Dr. Richard Rumelt, an expert in strategy from UCLA; and Dr. Robert Wah, president of the AMA, on shifting medical practice to bring real value to the patients. Tony O’Brien, director general of the Health Services Executive (whose brilliant idea it was to convene this deep, free-ranging discussion) sat for a grilling from health policy analyst Dr. Sara Burke. I delineated the toolkit, the strategies and tactics being tried in the U.S. and across the world to bring about a Healthcare Spring. I challenged them to make this moment in 2015 the time when healthcare in Ireland turns the corner and begins to develop something new, surprising, lean, powerful, astonishing.
Will these strategies and tactics work in Ireland? I don’t know, honestly. It depends on how bold they are willing to be. But I do know that there were revolutionaries in the room, willing to risk something to make healthcare work for the Irish people. There are people like that in every system I talk to.
People came up to me afterward, a surprising but not surprising number, saying some version of, “Funny you would use the term ‘revolutionary.’ I had never thought of that term. But yes, I am one. We have to change this and we can.”