Any health system is vulnerable to shocks from outside and crises from within. Some systems are more vulnerable than others because of the nature of their health systems, societies and economies. The Irish health system has only fairly recently emerged from a profound system shock in the shape of the austerity era and may face fresh shocks in relation to external events, such as Brexit. Nevertheless, the health system in Ireland is embarking on arguably the most radical transition it has ever planned with the Sláintecare reform programme to deliver universal healthcare. The challenge for health system policy makers and managers is to maintain the resilience and stability of the Irish health system to allow effective reform to occur whatever the circumstances, whilst not undermining system performance.
This research programme examines the key challenges facing the Sláintecare reform programme and evaluates strategies to facilitate its effective and thorough implementation in a complex adaptive system. It explores the legacy of the austerity period and how this has changed the health system for good or ill and reviews the causality of how shocks to the system challenge or even facilitate reform. In particular it evaluates public sector staff engagement over time both as a sign of resilience and a precondition for the implementation of effective change. The WHO Health System Building Blocks outline key components of a health system and these are used to evaluate system resilience and reform capacity. The proposed research combines both qualitative data from stakeholder and key informant interviews, with quantitative data from surveys of health sector staff, alongside a review of key system metrics and the progress of reform. It will develop evidence-based strategies for policy makers in government to manage the competing tensions between system performance and reform to achieve universal care through enhanced resilience.
