Canada experience proves invaluable in hospitals merger

Managing a hospital which will handle 5,000 patients a day, offer services as varied as cardiology and psychiatry and have a staff of almost 2,000 people, is a task Dr David McCutcheon approaches with a relaxed air. Although builders were putting finishing touches to parts of the hospital this week and some equipment was still being installed in wards, Dr McCutcheon did not exhibit a hint of panic. While he admits he is a workaholic and often tires himself out, he does not expect to be Tallaght's first patient.

His relaxed approach to the final details is perhaps understandable given the more serious obstacles the project has faced since it was first conceived three decades ago.

He admits that when he first stepped onto the site in 1996, surrounded by cement-mixing machines and scaffolding he was a little apprehensive. But when he met Department of Health officials and saw how serious they were, he was re-assured.

Being chief executive of a project of this nature is not much different to being a doctor - in both cases people come to you with a problem and they expect you to provide a solution, he says.

While all kinds of bridges have still to be crossed, he is not intimidated by the task facing him, because he has been there before; for a decade he managed hospitals in Canada, most of them larger than Tallaght. For almost three years he was chief executive of the Hamilton Civic Hospital in Ontario, Canada, which serves a catchment area of 1.7 million people.

The hospital was formed from the merger of two hospitals in Ontario and Dr McCutcheon's job was to gently knit them together. While doing this he had to implement a 10 per cent cut in the hospital's budget. This meant trimming the payroll by 10 per cent, mainly through an early-retirement scheme.

Through the Canadian experience, the fusion of different hospitals into a unitary structure has become his speciality. He believes he can do it again at Tallaght without threading on too many toes.

Those toes belong to the staff and management of the Adelaide, Meath and National Children's Hospitals, which will join together to form the new Tallaght operation. So far, despite the hold-ups and missed deadlines, the three hospitals have been working well, he maintains.

Dr McCutcheon says the task of merging three hospitals into one unit was the main reason he was attracted to the post. "I am really looking forward to seeing it all come together," he says.

The Adelaide Hospital Society's recent submission to the Working Group on Abortion, which advocated abortion where medically indicated and in line with the X case judgment, is not causing any tension at the hospital, says Dr McCutcheon.

"Those kind of questions will be adjudicated upon by the board of management and no such proposal has been submitted to them.

"If legislation is introduced by the Government permitting abortion then we will have to look at the whole question, but it is not a live issue at the moment," he says.

Dr McCutcheon says the hospital will closely guard the ethos of the Protestant Adelaide and will promote a "pluralist view". He says he has no role in formulating the hospital's policy, but is simply there to implement it.

What he hopes will carry him through is that he is firmly in touch with general medical practice (he lectures in Trinity College's medical faculty), but at the same time he is well versed in medical economics, management and human resources.

He acquired these skills during his time in Canada when he became restless with the idea of simply being a doctor. He found the systems used to administer health care extremely interesting and decided to study them at university. After completing a masters in business administration, he took his first health management job and has not looked back since.

He is a strong advocate of putting systems into hospitals which measure the real level of care patients are receiving. In addition, he sees himself as a hands-on manager, visiting wards, talking to staff and spending time with patients.

Although he has spent many years in general practice, he says he is able to turn down his colleagues requests if he thinks they are not right for the hospital. However, he says staff coming from the three merging hospitals will have the very best equipment and facilities.

The 76-bed private wing of Tallaght is not yet constructed and Dr McCutcheon does not expect it to open until August 1999. He says when it does open, it will surpass anything seen in private hospitals in the Republic before, particularly in terms of the space patients will have in their rooms.

The particular demographic profile of Tallaght is important to understand, he says. With such a young population, the care of children will be a major part of the hospital's work and will require a lot of resources and staff. He mentions another factor which makes Tallaght different.

"Up to 70 per cent of households in Tallaght have a smoker in them, so we have a job to do in terms of health information programmes as well." He realises the demands on the new hospital will be intense, but is determined that while the hospital will remain the State's most technologically advanced, each pound of taxpayers' money will be efficiently spent. He points to his Canadian experience again, which often involved scrutinising individual items of expenditure.

He says most of his time as chief executive, after the hospital admits its first patients, will be spent on managing resources and ensuring the correct standards of care are maintained. The question of budgets is one which has occupied his mind since he accepted the position in September 1996. He is currently in discussions with the Department of Health for more funding.

He says the £60 million annual budget for Tallaght will not be enough, and he is looking for another £10 million a year to fund additional services.

"While we would welcome extra funding, I have emphasised to everyone at the hospital that we have to spend our money responsibly."

Both the Irish Nurses Organisation and the Irish Hospital Consultants Association have said staffing at the hospital is inadequate. Dr McCutcheon rejects the allegation that patients will not receive the proper levels of care due to a lack of nursing staff in particular.

"We have adequate numbers of staff for the services we are planning, although we may need to take on more staff when additional services come on line," he says. He may have great difficulty in finding nurses in the Republic, however, as there is an acute shortage at present. In response, the hospital is likely to increase its intake from overseas, says Dr McCutcheon. Tallaght hopes to become a "magnet hospital" for the best medical staff available.

Dr McCutcheon is in the third year of a five-year contract, for which he collects an annual salary of £80,000, and gives every indication he would like to see it renewed by the Government. He never imagined when he left the Royal College of Surgeons in the early 1970s that he would come back to the Republic as chief executive of a large hospital.

Dr McCutcheon says the hospital now makes Tallaght a true community and he is enthusiastic about the benefits which it will bring to the area.

"Of the £60 million annual budget, about £45 million will be spent on salaries and we can expect a decent portion of that to be spent in Tallaght." The hospital will be sourcing a lot of supplies from the area too.