Understanding service reorganisation in the Irish health & social care system from 1998 to 2020: lessons for reform and transformation

Background: Given policy drives for integrated care and other reforms requiring service reorganisation this study analyses service reorganisation in the Irish health and social care system from 1998 to 2020 with the aim of identifying lessons for reform implementation and system learning generally. Methods: A mixed-method, co-designed study of three distinct datasets through in a policy document analysis, a thematic analysis of interviews with elite respondents, and a formal review of the international literature, sets the Irish reorganisation story in the context of services and system reorganisation elsewhere. This approach is apt given the complexity involved. Results: We find repeated policy declarations for forms of integrated care from the early 1990s in Ireland. These have not resulted in effective change across the system due to political, organisational and implementation failures. We identify poor clarity and commitment to policy and process, weak change management and resourcing, and reluctance from within the system to change established ways of working, cultures and allegiances. Given its narrative approach and identification of key lessons, this study is of use to policy makers, researchers and practitioners, clinical and managerial. It forms part of a bigger project of evidence building for the implementation of Sláintecare, Ireland’s 10-year health system reform programme. Conclusions: The paper captures important lessons for regionalisation of services delivery and other reorganisations in service-based systems more generally. We find evidence of a negative policy/implementation/practice cycle repeatedly missing opportunities for reform. Learning to break this cycle is essential for implementing Sláintecare and other complex reorganisational health reforms generally.

Digital pathology for intraoperative frozen section diagnosis of thoracic specimens: an evaluation of a system using remote sampling and whole slide imaging diagnosis

BackgroundDigital pathology is now used for primary diagnostic work as well as teaching, research and consultation. In our multisite institution service reorganisation led to histopathology being located in a separate hospital from some surgical specialities. We implemented remotely supervised specimen sampling and frozen section diagnosis using digital pathology. In this study we assessed the concordance of glass and digital slide diagnosis using this system.MethodsWe reviewed cases from the first 2 years of digital frozen section reporting at our institution. Cases with potential digital to glass slide discordance were reviewed by three experienced thoracic histopathologists. The reasons for discordance were determined and common themes identified. We also reviewed critical incidents relating to digital pathology during the study period.ResultsThe study population comprised 211 cases. Frozen section to final diagnosis concordance between digital and glass slide diagnosis was found in 196 (92.6%) cases. The 15 potentially discordant cases were reviewed. Intraobserver concordance between glass and digital slide review ranged from 9/15 to 12/15 cases across the three pathologists. Glass slide review diagnosis showed better concordance with ground truth in two cases; digital slide review was more accurate in two cases. One relevant critical incident was identified during the study period.DiscussionThis is the largest study to examine digital pathology for thoracic frozen section diagnosis and shows that this is a safe and feasible alternative to glass slide diagnosis. Discordance between digital and glass slide diagnoses were unrelated to the processes of whole slide imaging and digital microscopy.

An Overview of the Impact of Restructuring on Public Service in Nigeria

The Restructuring is the process of changing the lawful, possession, functioning, or other structures of an organisation to make it more lucrative or well planned for its current needs. The paper discusses the various mechanisms of public service reorganisation, which are economic steadiness, management productivity, confidence building and public transparency. It led to the downsizing and casualisation of a civil servant. This study aims to examine the impact of restructuring on public service in Nigeria. The methodology involves a systematic literature review which entails the document analysis of secondary data of the related subject matter. The discoveries reveal that restructuring sometimes invades on the right of a civil servant by stripping out their social security. The article concludes that the régime must halt unfair work practice such as cost-cutting and casualisation of employees, and advance right working environments to ensure civil servant double their effort.

Order out of chaos in surgical training?

I write this newsletter in the aftermath of the deplorable riots that took place in the major cities of our country this summer. Now that the riots have been quelled and the perpetrators dealt with by the courts we hear a cacophony of voices offering advice as to the causes of this violent upheaval. While I hesitate to draw parallels between this civil unrest and matters surgical, the clamour of voices proffering advice reminds me of the response to the health service reorganisation and, in particular, medical training and education.