CEO of Ireland’s largest and most complex hospital, Cork University Hospital (CUH), for 27 years, Clonakilty man Tony McNamara commenced his meteoric climb to the position, age 18, starting off in the Supplies Department of what was then known as Cork Regional Hospital. During his tenure, Tony worked his way right up from the bottom to take on the hugely challenging role of custodian of a hospital with over 40 specialties, 100 departments, and a staff of more than 4,000 multi-professional employees and approximately 500,000 patient interactions each year. Now retired, Tony (65), chats to Mary O’Brien about his journey, sharing some of the responsibilities that came with such a position, his views on the future of Irish healthcare, and how he is now quite literally enjoying ‘painting out’ a new work-life balance for himself in retirement.
Tony’s strong work ethic was shaped from a young age by his parents. The eldest of five children, he grew up as part of a working class family, in a small terraced house in Clonakilty. “My parents instilled great values in all of us,” he shares. “My father always worked very hard and his words, constantly reminding us not to forget where we came from, stayed with me over the years.”
Tony left his hometown in 1977, after completing secondary education, to begin his career at Cork Regional Hospital, which officially opened its doors in 1978. His early roles involved hands-on responsibilities, such as working in the Supplies Department and securing the premises each evening, which provided him with a foundational understanding of hospital operations, a knowledge base that would prove invaluable throughout his career.
Through his commitment and initiative, Tony quickly rose through the ranks. Within a few years, he had transitioned to the Internal Audit Division. This experience paved the way for his transfer to the administration department at Our Lady’s Hospital. In 1986, he returned to Cork Regional Hospital and worked in administration for three years. Here his leadership potential became evident and Tony, age 29, was appointed General Manager of University Hospital in Waterford, before going on to become CEO of Cork University Hospital in 1992.
Throughout his career, Tony was dedicated to continuing his education. He pursued a Diploma in Hospital Administration early on and later completed a Master’s in Change Management at Trinity College. While he embarked on a doctorate at Henley Management College in London, the 2008 financial crash curtailed his studies. However, he continued to seek advanced learning, completing a programme on managing healthcare delivery at Harvard Business School. This global perspective enriched his understanding of healthcare systems worldwide and reinforced his ability to implement innovative strategies at CUH.
Tony refers to the principals of a chess game – where success depends on respecting and empowering all contributors, from the seemingly humble roles (pawns) to the highest positions (queen) – to describe his approach to leadership.
“We must always respect the role and contribution of each and every member of the team and recognise that everybody has the potential to excel and should be supported in this endeavour.”
Like a good game of chess, he saw his role at the helm of a busy hospital as requiring an understanding of organisational dynamics, balancing strategic foresight with tactical adaptability to navigate challenges and advance key objectives.
Throughout his tenure, Tony strived to create and maintain a culture based on values such as empathy, the need to offer hope to patients, supporting innovation and change, but particularly demonstrating respect. All of which he says “helps to define the soul of the hospital”.
“It is a given that patients should be treated with respect, but it is also critically important to acknowledge the need to respect each other as colleagues and to respect the environment.”
The dilemma he says is maintaining one’s soul and not becoming depersonalised in responding to the myriad of competing demands placed on a CEO.
Appointed CEO in 1992 at a time when the hospital was struggling, as head of a new management team Tony faced a number of challenges, not least being tasked with reversing the hospital’s fortunes and reestablishing it as one of Ireland’s premier teaching hospitals.
Securing investment was a critical challenge in the early years but, by the mid-1990s, Tony and his team began to attract substantial funding from the Department of Health, which allowed for a significant transformation of the hospital’s infrastructure over the following decades, resulting in over €500m being spent on building projects during his tenure. Key projects included the consolidation of maternity care in Cork, bringing services from St. Finbarr’s Hospital, the Erinville, and the Bon Secour Hospital together onto the CUH campus. Other landmark developments included the construction of a state-of-the-art cardiac and renal centre, a new cancer centre in 2019, and an upgraded emergency department. These advancements not only modernised CUH but also established it as a leader in specialised care, with strengthened ties to institutions like the Christie Cancer Centre in Manchester.
He also reflects with pride on Cork University Hospital becoming the first hospital in the world to be awarded the prestigious Green Flag in 2015, by An Taisce’s Green Campus programme, on behalf of the international Foundation for Environmental Education. “This was a very important award and reflected the outstanding work that was done by very many staff who were conscious of the necessity to demonstrate that a hospital set on 50 acres in a built-up area could set an example for Ireland in terms of environmental sustainability. It is a further tribute to the staff of the hospital that this award has been maintained over the succeeding decade,” he says.
One of the greatest challenges hospital CEOs face, particularly in public hospitals, is the constant balancing act between immediate, short-term demands and long-term strategic goals. “During my own time in hospital leadership, I’d estimate that 90-95 per cent of my time was spent dealing with immediate operational matters.”
Dealing with high-profile issues, such as the number of patients on trolleys, will always be a struggle, as they often dominate public and media attention, acting as a “weather vane” for the health system. Tony explains that this narrow focus risks overshadowing other critical areas of healthcare.
“The on-going challenge to streamline the care of emergency patients and to reduce the number of patients on trolleys oftentimes mean that patients are inappropriately located in Assessment Units, which in turn compromises the functioning of those units for the purposes for which they were intended.
“The complexity of day-to-day hospital management was a persistent challenge,” he says, “in particular looking at the resources available to the hospital and their performance in terms of delivering quality care to patients.
“The priority can be to deal with an issue to address an immediate problem and in the process to make a decision that compromises another situation or indeed creates a further problem that may emerge at another time,” explains Tony. “A broader, integrated view is essential.”
He highlights the need for stronger partnerships between hospitals, community health services, and mental health services. “An integrated approach to delivering health care would give the public so much more value for the €24 billion that’s being spent on public health,” he says passionately. “I think we should push harder for this.”
He believes that unified regional structures, where all aspects of healthcare delivery align within a geographic area, offer an opportunity to maximise the value of public health spending.
“I don’t think it’s a matter of money, it’s a matter of organisation, and new structures and integration can ensure that patients receive comprehensive care while improving efficiency across the system.”
Tackling waiting lists is an ongoing issue in Ireland’s healthcare system and one that Tony believes requires innovative approaches such as implementing more of the virtual clinics we have seen since the Covid pandemic and strategies to reduce non-attendance at outpatient appointments. “Every missed appointment represents a lost opportunity for someone else to receive care and wastes valuable resources invested in organising clinics.”
Recruiting and retaining top talent is of course fundamental to delivering high-quality healthcare and Tony feels fortunate to have been able to recruit top class people during his tenure. He stresses the importance of attracting skilled specialists while supporting them with strong administrative teams, which are often the unsung heroes of hospital operations. “It’s something that unfortunately often goes unappreciated today.” Moreover, “we need to appreciate that employees have lives outside work and create a supportive culture,” he adds, which can foster a motivated and resilient workforce.
While he believes that life-work balance is important, Tony himself put in no less than 70 hours a week for many years. “I don’t regret it,” he says. “I was driven primarily in the interest of the public but also in the interest of the hospital and the staff to maximise the quality of care, the range of care, the access to care and so on. It wouldn’t have been possible to do the job working a 35-hour week. I felt compelled to set the example by working hard and I’ve no regrets about doing that.”
While many may argue the point, Tony doesn’t feel that the momentum behind Sláintecare has slowed down. He believes a problem lies in it being an all-party agreement, so while the concept may seem advantageous, it has limitations. “It means that there is an absence of discussion and debate on alternatives, which I don’t believe is healthy,” he shares. “The world has changed significantly since Sláintecare was agreed upon.” He mentions advances in technology, shifting demographics, and evolving public expectations, all of which demand a regular reassessment of healthcare delivery models.
In terms of the future of healthcare, Tony believes that delivery close to the patient’s setting remains fundamental. He again stresses the importance of integrating community services with hospital care as the way forward. While the public and private healthcare systems were forced to collaborate more effectively because of the Covid pandemic, the current healthcare system has shifted to public-only consultant contracts, Tony has spoken on a number of occasions about his belief that the coexistence of public and private practice on public hospital campuses would better facilitate access to top-tier consultants. “It remains to be seen if the current approach will be more beneficial for the public,” he says.
On the topic of healthcare system reform, Tony’s view is that the core issue isn’t funding but performance. Ireland’s healthcare budget has seen more than 50 per cent of an increase in recent years, rising from €16 billion six years ago to €24 billion annually. “The focus now must be on cultivating a performance-driven culture within the HSE and public healthcare. “This requires setting clear targets and incentives and establishing accountability.”
Recruitment and retention of talent remain another critical factor, as do technological advances. While Ireland has made strides in areas such as cancer care, Tony believes that more needs to be done, particularly in adopting cutting-edge treatments like proton therapy. This highly precise radiation therapy, which spares healthy tissues and organs, is especially beneficial for paediatric and certain cancer patients. Its absence in Ireland means many patients must seek care abroad. “It should be available here,” stresses Tony. “It’s part of the next generation of cancer treatments.”
Having worked his way up through the system, Tony credits his hands-on experience with giving him a deeper understanding of hospital operations. However, he believes that the absence of a structured leadership training programme leaves a significant gap in the system today. “When I was appointed general manager in Waterford in 1989 at the age of 29, I was fortunate to participate in a two-year executive leadership programme.” The programme, which included over 30 other emerging leaders, provided invaluable training in leadership.
“Unfortunately, I don’t believe similar structured programmes are readily available now, though perhaps they have been reintroduced since my time.” Tony believes that such programmes are critical to preparing future healthcare leaders. “To meet the challenges of today’s health system, we must identify individuals with leadership potential and provide them with comprehensive training, mentorship, and development opportunities.”
After retiring from his role at CUH in 2019, Tony joined the private sector, and still does a small amount of consultancy work. He has returned to CUH on a few occasions, but mostly on the other side, as a patient, with all of his experiences fortunately leaving a lasting impression of exceptional care. “Once you get past the initial point of entry, the quality of care delivered in our healthcare system is excellent,” he says. He says this reflects the dedication and professionalism of healthcare staff and again emphasises the importance of retention of talent in Ireland’s healthcare system.
Now enjoying a well-earned retirement, Tony says that while he doesn’t miss the intensity of the job “it was a remarkable privilege to be charged with the responsibility of contributing to public life and to the delivery and development of something as critically important as healthcare, which impacts on everybody.
“We are but custodians of the roles we fulfil in life…and I gave it my best shot.”
After gaining a new appreciation of work-life balance, he feels fortunate to have retired from such a challenging role with his reputation and his health intact. Today he is enjoying rediscovering a passion for art at the Clonakilty School of Painting. He is also learning to play the piano, has taken up French lessons, has developed an appreciation for literature and plays golf.
His advice to anyone stepping into a leadership role in healthcare is “to fully embrace the opportunity to develop their skills, competencies, and vision for how they can contribute to and enhance the health service.”
For those fortunate enough to be given this opportunity, his advice is to “seize it with both hands and focus on how to add genuine value.
