Mr. Stephen Mulvany:

It is not just about management, as in, if there are good processes, there are good managers and if there are bad processes, there are bad managers. It is not as simple as that. A combination of factors come together, such as the right staff and right capacity. Often, an investment in beds can be, as I said, a catalyst to enable people to get some hope, make some changes and build on that. Sometimes it is down to relationships. Clinical managers and clinical leaders are important. There are a range of factors and we do not want to oversimplify it. It is not in the interest of patients, staff or managers to point at a hospital and say that big trolley numbers equals bad managers. There is room for improvement in processes everywhere, including in places like Waterford. It is everywhere. The issue is supporting the system to adopt. Health does not generally adopt a much more systems and operations approach to how it manages processes, recognising that these are patients and not products that we are making. However, there are elements of that thinking that can, will and should be introduced into healthcare to the extent that they have not yet. One will hear people talking about “lean”, which is an overall way of approaching services that puts the patient first and looks at what improvements can be made - not to make the staff work harder, faster or longer, but to help staff take out steps in a process that add no benefits to patients or staff.