The RESTORE research programme examines the key challenges facing the Sláintecare reform programme and evaluates strategies to facilitate its effective and thorough implementation in a complex adaptive system. It reviews the causality of how shocks to the system (such as COVID and the 2008 financial crisis) challenge or even facilitate reform. In particular, it evaluates public sector staff engagement over time as both a sign of resilience and a precondition for the implementation of effective change. The proposed research combines both qualitative data from stakeholder and key informant interviews, with quantitative data from surveys of health sector staff, alongside a review of key system metrics and the progress of reform. It will develop evidence-based strategies for policy makers in government to manage the competing tensions between system performance and reform to achieve universal care through enhanced resilience.


RESTORE project Components:

This component draws on the growing international literature to consider resilience as the management of a shock cycle and assesses how resilient Ireland is to shocks, recovering from austerity, and now embracing new shocks like COVID 19 or Brexit. In so doing, the research helps build theory around the resilience shock cycle, an innovative approach drawn from Thomas et al 2020. It also seeks to deliver practical knowledge of the most effective strategies to be pursuing to boost health system resilience in Ireland's evolving context.

This component seeks to evaluate the development of Sláintecare within a broader context of managing complex systemic reform. It identifies similar case studies of complex comprehensive reform from the international literature and charts their progress and the reasons for changes in design and implementation. The researchers then evaluate how Sláintecare is evolving and progressing according to plans and key metrics. The research will determine to what extent the integrity of Sláintecare is preserved and what are the key factors that have, are and will influence its development. This will allow an interesting comparison with the other international case studies identified.

Staff engagement and motivation is a key determinant of health system performance, resilience and willingness and ability to embrace change and reform that will be required to deliver Sláintecare. This component will then focus on analysing and reanalysing date on HSE staff engagement, to draw out particular features for subgroups and trends, matching these results with data from the patient experience survey. Finally, it will undertake Focus Group Discussions amongst specific staffing groups on the causes and consequences of staffing engagement trends and features.

The final component of the project will build theory around the dynamic nature of health system resilience and reform drawing on earlier components. It will follow the approach taken by Shepherd and Suddaby (2017) in understanding theory building in narrative terms, exploring tensions and core constructs to bring fresh revelation from an empirical base. The theory building section will also utilise insights from a realist approach, which can provide a nuanced framework for investigating the impact on the system of actors’ interpretations, actions and reactions.

Principal Investigator
Professor Steve Thomas, Edward Kennedy Professor of Health Policy and Management, Trinity College Dublin

Funded Team
Dr Liz Farsaci, Research Fellow, Centre for Health Policy and Management, Trinity College Dublin
Catherine O’Donoghue, Researcher, Centre for Health Policy and Management, Trinity College Dublin
Dr Arianna Almirez-Sanchez, PhD Scholar on SPHERE, Centre for Health Policy and Management, Trinity College Dublin

Professor Richard Layte, Professor and Head of Sociology, Trinity College Dublin
Professor Carolyn Hughes Tuohy, Professor Emeritus, University of Toronto
Dr Josep Figueras, Director, European Observatory of Health Policy and Systems
Philippa Ryan Withero, Assistant National Director, Integrated Workforce Plannng, Health Service Executive 
Greg Dempsey, Deputy Secretary (Corporate Affairs), Department of Health 


Dr Sara Burke, Associate Professor, Centre for Health Policy and Management, Trinity College Dublin
Dr Sarah Barry, Associate Professor, Royal College of Surgeons Ireland
Professor Susan Smith, Professor of General Practice, Trinity College Dublin
Dr Louise Caffrey, Assistant Professor, Social Policy, Trinity College Dublin
Dr Emer McGowan, Assistant Professor, Physiotherapy, Trinity College Dublin
Dr Conor Keegan, Head of Health Insurance Regulatory Affairs, VHI Group
Dr Jon Cylus, Economist and Research Fellow, London School of Hygiene and Tropical Medicine

International Advisory Committee
Mr Colm O'Reardon, Secretary General of the Department of Further and Higher Education 
Ms Laura Casey, Principal Officer, COVID/NPHET Policy, Office of the Chief Medical Officer, Department of Health 
Ms Anne Marie Hoey, National Director of Human Resources, Health Service Executive 
Dr Margaret O'Riordan, President, Irish College of General Practice
Ms Jacki Conway, PPI representative and Chief Operating Officer, GlobalWealth
Ms Laura De Búrca, PPI representative
Dr Sara Van Belle, Research Fellow, Institute of Tropical Medicine, Antwerp, Belgium
Professor Ilmo Keskimäki, Research Professor, Finnish Institute for Health and Welfare and Professor, Health Services Research, Faculty of Social Sciences, Tampere University, Finland