When Stephen Donnelly burst onto the political scene in 2010 much was made of his background in management consultancy. An alumnus of MIT and the Harvard Kennedy School of Government, he had worked for McKinsey for a decade.
McKinsey, one of the oldest and best-known US management consultancies, has been the subject of numerous books and articles. About the only thing they agree on is that you have to be very bright to get a job with them.
We don’t know that much about what Donnelly did at McKinsey but, by the time the financial crisis rolled around in 2007, he was more qualified than most to understand and articulate what was going on to a worried and bewildered public. He took leave from McKinsey to run for the Dáil as an Independent in 2011 telling Kathy Sheridan in an interview with The Irish Times he had been triggered by the arrival of the International Monetary Fund to oversee the €67 million bailout of Ireland. “This is a national emergency, and at times of national emergency, people stand up,” he explained.
Fast forward 13 years and he is now the Fianna Fáil Minster for Health following stints as an Independent and cofounder of the Social Democrats. It is fair to say he toned down the “smartest guy in the room” shtick somewhat over the years. It was a sensible move. People like their politicians to be relatable rather than intellectual and Fianna Fáil would not be noted as a hotbed of blue-sky thinking.
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It would appear, however, that Donnelly has rediscovered his inner management consultant when confronted with the Sisyphean task of trying to keep the health service on budget and get waiting lists down.
It looks very like Donnelly’s initiative will be defeated by the inertia of a system hamstrung by competing vested interests. In this case, it’s consultants
Last week, he announced that, from next year, funding for new consultants will be prioritised for hospitals which can show that their existing consultants are working as hard as all the other consultants. The primary measure of how hard they are working is the number of outpatients consultant teams see compared to other teams in the same speciality.
Donnelly wants them to see as many outpatients per head next year as they did in 2016. If they had done so this year then another 1.4 million appointments would have taken place, he calculates. There are currently almost 600,000 people waiting for an outpatient appointment. Problem solved? Unlikely.
Donnelly grounded his initiative in “the data”. He said that it showed “shows significant variations in the average number of outpatients being seen by consultants in the same speciality” and “a big reduction in the overall number of outpatients being seen per patient-facing consultant”.
Delivering improvements on the “new-to-return ratio for outpatients” – boosting the number of new patients – and other reforms would play a significant role in determining budgets for hospitals next year.
His fluency in management-consultant speak conjures an image of a minster pouring over spreadsheets late into the night before having a eureka moment – if I can only get these guys to see as many patients as they did in 2016. It plays into the cliche of Donnelly as some sort of recovering management consultant obsessed with measurement and less alert to the softer issues.
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Donnelly’s maths may be correct, but he seems to have failed to ask himself one question: if you were a consultant in an Irish hospital right now and were told by management that you have to see 30 per cent more outpatients next year or else you might not get money for another consultant post, what would you do? Decide to work 30 per cent harder for the same – albeit generous – pay, or ring the Irish Medical Organisation?
The phone call has already been made. The IMO wasted little time in pointing out what they say is the unworkability of the initiative. The biggest problem, according to the IMO, is the difficulty of comparing like with like, as there are numerous factors that could affect a consultant’s productivity other than his or her work ethic. Prof Matthew Sadlier, chair of the IMO’s consultant committee, listed access to clinics, patient treatment complexity, and access to diagnostics, beds and theatres among other factors. The Health Service Executive has admitted as much to them privately, they claim off the record.
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It looks very like Donnelly’s initiative, like so many others in health will be defeated by the inertia of a system hamstrung by competing vested interests. In this case, it’s consultants. But it could easily be religious orders, the nurses and local politics.
From this perspective, the apparently doomed attempt to make consultants work harder in the common good may not be as pointless as it first appears. If nothing else, it will help change the narrative around waiting lists from one of incompetent administration and budget cuts to lazy consultants. That would not be a bad result with an election in the offing. It’s more canny politician than brainiac management consultant.