The new CEO of Health Service Executive has said the organisation is very centralised and top heavy.
In his first interview since taking up the post, Bernard Gloster said the system must change to ensure timely interventions for the public.
Mr Gloster took over as the new HSE chief on Monday.
Among the biggest challenges he faces, are long hospital waiting lists, overcrowding and the pace of promised health reforms.
Mr Gloster described the HSE as very centralised and a top heavy organisation at the centre.
He said this makes it very difficult for people who are working outside the system and those running hospitals or community services to make timely decisions for patients.
Mr Gloster said he met every senior manager in the service yesterday and told them the current delay in discharging people from hospital who are ready to leave was unreasonable.
He also said the new consultants contract is very attractive, to what was there before.
His comments come as the Irish Nurses and Midwives Organisation said there were 634 admitted patients waiting for a bed in hospitals around the country, with 513 people waiting in emergency departments.
The hospitals worst affected are University Hospital Limerick with 90 patients waiting, University College Cork with 73 and St James's Hospital in Dublin with 46.
There were 18 admitted patients waiting for a bed across the three children's hospitals at Crumlin, Tallaght and Temple Street.
Earlier, Minister for Health Stephen Donnelly said that cutting hospital waiting lists by 10% this year is a realistic target, adding that last year's targets were "probably overly ambitious" and the Omicron wave of Covid-19 compromised the ability to deal with waiting lists.
This year's action plan allocates €363 million from the Budget to help reduce lists, which stood at over 823,000 in January
'Disappointing' reaction to new consultant contract on offer
Meanwhile, Minister Donnelly said the reaction to the new consultant contract proposed by the Government and the HSE is "disappointing".
From today, the only contract of employment that will be offered to new consultants, consultants who wish to transition from existing contracts, or consultants changing employers, will be the new Public Only Consultant Contract (POCC).
Consultant and non-consultant hospital doctor (NCHD) members of the Irish Medical Organisation (IMO) rejected the new contract, with 57% of current contract holders in the trade union indicating they will not switch.
Speaking on RTÉ's Morning Ireland, the minister said the Government will go ahead with the contract, and ruled out new talks on the matter.
"We are offering a contract now which is very attractive. We're offering a contract that pays €257,000 for 37 hours' work.
"When you add on on-call, many consultants will earn over €300,000 and on top of that."
The IMO said that 59% of consultants currently working overseas say they will not return to Ireland to take up the contract.
It will see consultants rostered on Saturdays for the first time.
It changes the relationship that currently exists between the public and private practice of consultants.
Consultants will not be able to do private work on the public hospital campus but can opt to do private work off-site in their own time.
