Senior managers in the National Ambulance Service are concerned that they lack the key skills to carry out their work.
The concerns came to light in interviews with the Health Information and Quality Authority during its review of the service.
HIQA Chief Executive Phelim Quinn told RTÉ's This Week that senior managers told HIQA inspectors they were not comfortable with the skills they had to carry out their jobs.
Mr Quinn said: "A number of key managers gave us the impression, because it wasn't certainly given to us by any other source, that they had some degree of discomfort about the jobs that they had found themselves in.
"They expressed to us some concern that they didn't have the technical competencies required for these senior leadership positions.
"We believe that the HSE in appointing people need to be absolutely assured that the people appointed have the appropriate technical competencies and other leadership and management competencies required for those roles."
Mr Quinn also told This Week that senior ambulance service managers said they had no specific job description for the roles they occupied.
He said: "A number of them said that they didn't have an aligned job description.
"That concerned us because if we were to look at the ambulance service setting a very clear strategic direction for itself, we believe their job descriptions need to be aligned to that strategic direction.
"Some of them had indicated that those job descriptions were not specifically present."
On foot of this, HIQA has called on the Health Service Executive for the job descriptions of all senior management to be reviewed and for all senior managers to receive leadership development training.
In a response to the HIQA concerns, the HSE told This Week that it was "not supplied with any information or data other than the review report in support of the conclusions drawn by HIQA".
The HSE also said that all staff have job descriptions and that accepting jobs is a matter for the applicants themselves.
It said: "In general, appointments to the NAS are made by way of transfer, internal or external competition.
"Interviews are conducted for each competition and job offers are extended to for the individuals to acceptance or not.
"Graduates from the [Pre-Hospital Emergency Care Council] school are appointed to frontline services after graduation.
"All staff have job descriptions and performance is reviewed in line with HSE policy."
Mr Quinn indicated some of his concerns to the Oireachtas Health Committee during the week.
Members of the committee called for the HSE to appear before them to answer questions on the HIQA concerns.
