Health reform is impossible until managers can be held accountable
The heated exchanges between the HSE and the Health Information and Equality Authority (Hiqa) regarding the latter's report on the pattern of infant deaths in Portlaoise Hospital highlight a matter of the utmost importance - the accountability of senior managers when things go wrong.
Enquiries into calamitous institutional failures and individual tragedies have commonly focussed on the part played by the front-line staff, to the exclusion of senior managers and boards. So, for example, a report last year into the death of Savita Halappanavar in University Hospital Galway found that of the 30 staff "directly involved in her care" nine had a case to answer for, while 13 "missed opportunities" to prevent the tragedy.
If 13 opportunities to prevent a tragedy are missed then the root cause is not simply human error or individual incompetence. This is evidence of a "systems" failure. But if it was a systems failure, then who was responsible for the design, implementation and maintenance of systems? And the answer is: managers at different levels and possibly board members, senior civil servants or the relevant minister. It is they who are responsible for such elements of the system as the structures of accountability, safe and efficient care pathways, compliance with 'best practice' clinical protocols, training, adequate funding and legal frameworks.