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A Hospital Executive talks about Healthcare Innovation in today’s climate.

Lorcan Birthistle, CEO of Saint James Hospital, Dublin, Ireland


What is your personal story, what brought you to work in healthcare?

My first year in employment after leaving school was as a hospital porter, which I did for about a year. I then got a clerical job in one of Dublin’s hospitals and have been working in hospital administration and management since. I rose up through the ranks and have been a hospital CEO since 2001. I find hospitals an exciting and challenging place to work. I have never worked anywhere else so I am poorly placed to compare it to any other sector but I think it is about as interesting, potentially rewarding and frequently frustrating as a workplace can be.

Where do you think the Irish healthcare system is going and what do you think needs to be done?

There is a lack of real investment in doing things differently and taking chances on change. It is widely accepted that our system are not fit for purpose but there is limited agreement about how we should respond. Frequently changes in structure are proposed usually because this appears easier than actual service reform.

We do not have a good record of rewarding outcomes. Instead we focus on inputs and outputs. The old adage ‘what is measured gets managed’ is true but the question is are we measuring the right things? Frequently I don’t think we are.

We are poor at identifying what is of value to our patients. This may be a consequence of a big system under pressure to respond to demand and without the time to respond to individual or group needs. We frequently end up in a position where there is a political response to individual cases which capture media and public attention which are then interpreted as an indicator of how the system as a whole is performing.

What is the toughest challenge in spreading evidence based innovation across an organization or a region?

The biggest challenge can be getting the evidence or data to demonstrate how an innovation is working. There is also a challenge in getting staff protected time to do something different which may or may not actually work. The spreading of innovation from one area to another within the hospital remains difficult. This is only more so across the region. There is an element of circumstances being different in each location and there is also the NIH (Not Invented Here) syndrome. Understandably, people who want to have a sense of local ownership and initiatives that don’t have some element of local organic growth, face an uphill journey. 

Of the innovation projects you’ve observed, what are the most common problems they set out to solve?

Frequently the initiatives are built around efficiency and have some element of economic benefit. I think this is born out of a not unreasonable perception that executive support will be dependent on economic efficiency. The underlying issues being addressed are most frequently service delivery either quality or access. Cost increasing innovation is the most difficult to achieve. Even if a reasonable argument can be made that cost is being avoided elsewhere in the health system this will not get support if the benefit can’t be seen in the hospital, which will carry the cost of innovation.

What are some of the most cost effective decisions executives have made regarding innovation that really moved the needle and produced results or significant improvements?

The question is based on the premise I mention above that cost effectiveness and innovation are intertwined. This is a risky approach as it can negate innovation for improvement in quality or access.

The most effective innovations made regarding tend to be small scale change which gets imbedded due to local involvement. In my opinion the executive’s role is most often to create an environment where innovation is valued and encouraged. In particular, that innovation which does not work or sustain is examined and understood with a view to future success rather than as a post mortem.

What advice would you give with regards to leadership and innovation to new leaders or entrepreneurs?

For leaders it is very difficult to strike the balance between ‘business as usual’ and innovation when the ideal is that innovation in itself becomes ‘business as usual’. I think we should give the staff at the frontline the space to innovate. I do not want to bring people in the ‘do’ innovation as it can appear like a cushy number to staff who are under real pressure to deliver services. The reward for working hard and doing a good job should be protected space to innovate which is viewed as part of doing your job well.

For entrepreneurs it can be very difficult to access big complex organizations like hospitals. My advice would be to be clear there is a problem to be solved and that they have clarity about their potential solution. Do your homework. All too often I have seen solutions desperately searching for problems. On the other hand, hospitals are full of bright well-educated people who are passionate about what they do and want to do it better. This is very fertile ground for entrepreneurs if they prepare properly. 

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