Project Area: Health policy and systems research
Project Summary
Ireland’s health system is undergoing a substantial period of structural reform. Central to this transformation is the introduction of six new HSE Health Regions, alongside a reconfigured HSE Centre, with responsibility for planning, managing resources, and delivering services increasingly devolved from national to regional level. This reform, aligned with the Sláintecare strategy, aims to strengthen governance, improve accountability and transparency, enhance performance, and support the delivery of integrated care closer to communities, ultimately improving population health outcomes.
Despite the scale and ambition of this reform, international experience shows that structural change alone does not guarantee better health system performance. Whether decentralisation leads to more effective, integrated, and responsive care depends on how decision-making authority is exercised in practice, the capacity of leaders across organisational levels to act, and the accountability relationships linking national, regional, and local actors. Understanding how these factors interact during implementation is critical, particularly at this early stage when governance norms, managerial behaviours, and service delivery models are still taking shape.
This PhD project will generate policy-relevant evidence on how Ireland’s new health system structures are reshaping governance, decision-making, implementation capacity, and integrated care delivery at national and regional levels. To do this, the research uses a multi-method, multi-level design structured around three interlinked work packages. First, it will synthesise international evidence on how decision-making authority, capacity, and accountability are analysed in studies of health system reform in high-income countries, informing the development of research tools. Second, it will analyse the roll-out of HSE Health Regions and a reconfigured HSE Centre through stakeholder mapping, documentary analysis, and interviews with key actors, examining how decentralisation is functioning in practice. Third, it will conduct an in-depth regional case study of Integrated Health Areas in HSE Dublin Midlands, exploring how governance arrangements influence the implementation of integrated care across acute, community, and voluntary sectors.
Findings across the three work packages will be integrated to provide a coherent picture of how reform, governance, and implementation interact, and how these dynamics affect service integration and workforce experiences. By generating timely, applied evidence during the reform process, the project aims to support policymakers and system leaders responsible for implementing reform, strengthening health system performance, and improving population health outcomes.
Skills Required
(If applying for this project you will be asked to outline how you meet the skills required below)
Essential
- Academic qualifications
a. A strong primary degree (2.1 or equivalent) in health or related areas (e.g. public health, healthcare or social science disciplines)
b. A strong Masters degree in a related area - Demonstrated experience and understanding of research methods and study design, including qualitative methodology and descriptive statistics
- Excellent written and verbal communication skills, and demonstrated commitment to dissemination
- Excellent project management skills and proven ability to work to deadlines
- Ability to work effectively in a multidisciplinary team
- Strong interpersonal skills
- A fluent command of the English language
Desirable
- Familiarity with the Irish health system, particularly its governance structures and reform processes
- Proficiency in data analysis tools and software (e.g. NVivo)
- Prior research and publishing/presentation experience in health policy, systems and governance
- Experience of engaging with stakeholders at local, national and international levels and across sectors, including between research, policy and practice settings
Supervisory team:
Dr Carlos Bruen, PI/Primary Supervisor
Assistant Professor in Health Policy & Public Health, Centre for Health Policy and Management, Discipline of Public Health and Primary Care, Trinity College Dublin.
Prof Sara Burke, Associate Professor and Director of the Centre for Health Policy and Management, Discipline of Public Health and Primary Care, Trinity College Dublin.
Dr Elaine Toumey, Lecturer in Evidence Based Healthcare and Cochrane Ireland/Evidence Synthesis Ireland Research Associate, School of Nursing and Midwifery, University of Galway.
International Advisor
Prof Sara Allin, Associate Professor of Health Policy, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto and Director of the North American Observatory on Health Systems and Policies (NAO).”
This project will be based in TCD
