Management of Health Services in Ireland: Identifying the Determinants of Process Effectiveness in Health Related Services

The term effectiveness presents a conceptual challenge to both academics and practitioners (Hirsch & Levin 1999). This is no less so in health care provision. Health care provision is a complex issue due to political, organisational, medical, technological, and multi-disciplinary approaches to solving health cases. Additionally, health care in Ireland is a multi-agent provided service, delivered through a variety of modes including market exchanges, networks and hierarchies. These complexities have resulted in multifaceted systems of service delivery and management that give rise to difficulties involved in the management of the health system particularly in terms of coordination which is linked to the construct of process effectiveness that is developed. These difficulties relate to the lack of understanding of process effectiveness within the present system and its determinants. At present we don't know a lot about process effectiveness or what determinants process effectiveness in the Irish health care system. Those responsible for the design of health services are faced with a dearth of information on what determines process effectiveness (Barrington 2003; Department of Health and Children 2001; Koeck 1998; Millar & McKevitt 2000; Page 2003). Health research in Ireland has not focused on service evaluation, which would provide a greater understanding of process effectiveness, and, while there is some annual statistical data available on the use of existing resources, there has been little evaluation of the effectiveness of service programmes (Barrington 2003; Deloitte and Touche 2001; Department of Health and Children 2001; Downey-Ennis & Harrington 2002; Government of Ireland 2003; Hensey 1988; Leahy & Wiley 1998; Millar & McKevitt 2000; O'Sullivan & Butler 2002; Prospectus & Watson Wyatt 2003; Wiley 2000). The lack of evaluation and/or measurement of effectiveness poses a serious challenge to the management of health service delivery. As McKevitt and Keogan (1997:20-21) identify without measurement there can be no clear view on progress towards strategic objectives and there is no meaningful basis for managerial action. This study addresses the concept of effectiveness as it applies to health care service provision and develops a construct of process effectiveness. A model is developed that will assist in the operationalisation of the effectiveness construct that can assist those responsible for health care service delivery to increase its effectiveness. The framework seeks to address the gap in our understanding of what determines process effectiveness at the level of service delivery by applying management and organisational approaches to Irish health care services.