Strategic Change in the Irish Health Services: Comparative Case Studies in Planning

This paper reports on a study of the implementation of service planning in the Irish health services in the context of significant organisational change. One of the central mechanisms of the Strategic Management Initiative (SMI) is the devolution of accountability and responsibility from the centre to executive agencies. Service planning in the Irish health care sector is seen as part of this strategic planning ethos. This study in examining the function and implementation of the service plan in the Irish health care system drew comparisons with the Canadian experience. A multiple case study design was utilised. Key research questions were tested through analysis of legislation and documentation as well as qualitative interviews with middle and senior management throughout the health care system. The choice was made to study the dynamics of strategic change in their setting by investigating a number of health boards during 2004-2005. The focal points of analysis were structured around three cases in the Irish context and one case in the Canadian context, as well as accounting for the wider institutional influences; the context in which those cases were situated. This wider view included looking at other stakeholder perspectives, including government and other health care organisations in the health care system, and examining the legislative influence. The study narrowed down the conceptual framework to a number of key problems with the Irish experience. The implications for practice derived from the case analysis are presented.