HSE's use of model meant for private sector undermines patient care, says professor

The HSE's focus on key performance indicators (KPIs) initially came from wanting to be more transparent but actually creates a management class in the healthcare system. File picture

Health services have become too focused on counting patients instead of treating the sick, with stark results for children’s mental health, a University of Limerick psychology professor has said.

Professor Orla Muldoon warned against the ‘managerial’ approach to hospitals, which can ignore people working in a system in favour of counting outcomes.

“Each patient is different and requires individual care, but the managerial model actually undermines the model of care that we want,” she said. “We have started to care too much about the indicators and not enough about the care.” 

Prof. Muldoon, who specialises in social and political psychology, said this model was developed for the private business sector with the understanding that more production requires more investment.

For the HSE and the NHS in the UK, she said: “It is a really alluring idea (applied) that if you just manage things better, you could actually achieve more with the same money.” 

The focus on key performance indicators (KPIs) initially came from wanting to be more transparent, she said.

“A vast amount of effort is spent on counting KPIs, instead of spending a vast amount of effort on looking after people. One of the things that does is it creates a management class in the healthcare system,” she said.

“All of those KPIs are normally recorded every three to six months, and there must be a minimum of 10,000 being collected across the services.”  A list of HSE key performance indicators takes 122 pages, including for Child and Adolescent Mental Health Services (Camhs).

“Managerialism is built on the idea you are producing X number of things that are all the same. There is no equivalence between a child who has a very severe ASD and a child who is mildly anxious,” she said.

“But what happens is they both get 15 minutes or sometimes seven, depending. You can see that having consequences; there is an allotted amount of time for each person. The KPI would be that X number of people get through the system in X number of hours.” 

Digital records

Meanwhile, gaps in digital patient records for Camhs and delays with a national electronic health record have been highlighted this week. Prof. Muldoon said one consultant she knows read 1,100 paper patient files at the start of Covid-19 vaccinations to identify vulnerable patients.

“We have a situation where we can’t manage digital records of patients, and that really should be the centre of a modern healthcare system,” she said. “We have hundreds of KPIs being audited and managed all the time. From the point of view of people working in the system, that is really frustrating.” 

She called for "a multi-layered solution" to include not targetting so many resources only on counting. 

The Irish Hospital Consultants Association support Prof. Muldoon’s argument, saying almost eight in 10 doctors are burnt out which they linked to increasing demand without support.

“A laser-like focus is needed to deliver the two vital resources every patient needs, hospital beds and hospital consultants. 5,000 hospital beds are needed by 2030 to meet current and expected demand," a spokeswoman said.