Sunday, December 14, 2014

The Department Of Health Is Called For Not Evaluating Their E-Health Program. They Really Are Just Hopeless!

As a special for the last week of the year the blog provides two takes on this issue.
We both review a Capability Review of the Department of Health From the Australian Public Service Commission. Link to full report is found below. 
First from Karen Dearne we have her view which picks out all sorts of issues at DOH!
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“The Australian Public Service Commission's findings of serious inefficiencies and dysfunctional culture within the federal Health Department will not come as a surprise to those who have had dealings with senior executives and their middle managers.
The Sydney Morning Herald's Canberra workplace writer, Noel Towell, has today painted a bleak picture of "80 hour weeks, bullying, command and control" management following a Capability Review conducted by the APSC.
The report also warns there is an "urgent need to address inadequate governance arrangements and delivery frameworks".
"Decision-making has been largely centralised at senior levels, with a number of leaders being described by employees and stakeholders as exercising a command-and-control leadership style," the APSC report says.
"While this approach may be appropriate in responding to a crisis or national emergency, its application in day-to-day management has resulted in the disempowerment and poor use of its workforce, reinforced vertical silos, limited corporate ownership and potentially hampered innovation.
"The department's governance arrangements appear disconnected, which may be a function of their design."
Reviewers found additional financial investment is required to "modernise and ensure the department's ICT environment is secure and fit for purpose. While the department is acutely aware of the shortcomings and associated risks of its ICT systems, resolving this to an appropriate standard will likely require accelerated, concerted and sustained focus".
The review team "regularly heard" examples of risk aversion, tight control of information, micro-management, elevated decision-making and an excessive focus on issues management.
"Employees provided the team with examples where red traffic lights were not placed on management reports until risks were quite advanced, as they thought bad news would not be welcome," the report says.
"Employees regularly commented on personal fears of making a mistake, with some saying the 'department does not make mistakes'."
The report says the department should lead "more purposeful engagement and partnership" with external organisations.
"A majority of external stakeholders, including other (government) agencies, reported they have experienced the department as increasingly insular and often outwardly defensive," it notes.
"Stakeholders often commented on the difficulty in interacting with the department compared to other policy departments which were seen as much more open, though still professional and able to manage competing interests.
"In an increasingly contested policy environment, the department needs to ensure it adequately captures the views of stakeholder groups who often hold positions of authority and influence within the community.
"Incorporating a broad range of external policy perspectives into the department's advice remains crucial to its continued position as a trusted and key policy adviser to the Government."
The review team says the department's former secretary, Jane Halton, was recognised "for setting clear expectations for the department’s performance and she was respected for her intellectual and results-focused leadership".
But employees reported "a need for an overarching narrative that communicates a clear and coherent direction for the future".
And, "despite the efforts of the former secretary to break down silos, most employees and stakeholders described the department as hierarchical and siloed".
The new Enterprise Data Warehouse and the Personally Controlled E-Health Record system have been singled out as evidence of the department's "many highly capable employees, with deep subject matter expertise and a well-educated workforce".
Health employs "highly credentialed medical officers and other professionals with relevant qualifications to help inform internal policy and program decisions. It has access to rich data repositories, is developing an Enterprise Data Warehouse and is working on a broad e-health program which has the potential to strengthen the department’s platform for evidence-based approaches" to policy development.
The EDW, in particular, is seen as an opportunity for opening access to public health data for broad reporting and research purposes.
"The objective of the warehouse is to enable shared health information, greater accountability and unprecedented data transparency so future generations of Australians can be confident of a sustainable, nationally unified, locally-controlled health system," the report says.
"A work in progress, the EDW requires ongoing investment to realise its potential by the department and others, as well as solve data storage and privacy obligations in legislative requirements.
"There is an opportunity to underpin strategy development and policy formulation through greater analysis of data, within, across and beyond the (commonwealth) public service.
"Rich repositories of data exist at policy and program levels, particularly in the Pharmaceutical Benefits Scheme and Medical Benefits Scheme. These data sets have the ability to help shape the strategic agenda."
And the PCEHR? The department is awaiting the Government's decision on the Deloitte "Refresh" Review of the program, undertaken in May 2014.
"The review has the potential to influence e-health system design, implementation schedule, and planning for communication, education and risk management," the report says.
"The department needs to evaluate and measure outcomes relative to original expectations and investments made to date in the PCEHR against a strategic agenda."
In response, the new Health Secretary, Martin Bowles, has welcomed the report, saying it "provides an opportunity to take the department forward, build our capability for the future and make the department the best organisation it can be".
"A review of existing arrangements is currently underway to ensure the department’s governance and delivery systems are aligned and sustainable to face future challenges," Mr Bowles says.
"One key area I plan to focus on is to ensure decision making is not centralised and that decisions are being made at the right level.
"As acknowledged in the report, the department has commenced work to break down silos. Our focus moving forward is to ensure we work across internal boundaries and limit potential duplication while fully utilising our highly capable workforce."
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Second, here is my view which looks more closely at e-Health issues!
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A little while ago the Australian Public Service Commission produced a Capability Review of the Department of Health.
There is some interesting material contained therein - with a number of areas of the Department definitely not receiving a glowing assessment.
Here is the link to the report:
The report is dated October 2014.
There were two of three areas that interested me:
P12.
First I was interested to discover that 229 people work in the section of the Department described as Information Technology and e-Health.
P37.
Second I found this section revealing.

e-Health

The Government has indicated it remains committed to an e-Health system that delivers real benefits. It has made a further $140.6 million available in 2014–15 for the operation of e-Health and the PCEHR system while it considers the recommendations of a review undertaken in May 2014. The review has the potential to influence e-Health system design, implementation schedule, and planning for communication, education and risk management. The department needs to evaluate and measure outcomes relative to original expectations and investments made to date in the PCEHR against a strategic agenda.
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These are weasel word of the first water!
“The Government has indicated it remains committed to an e-Health system that delivers real benefits. ”I wonder what this system is and how the Department knows what benefits it is delivering?
“The review has the potential to influence e-Health system design, implementation schedule, and planning for communication, education and risk management.” And just what has anyone been told regarding all these matters? What options and what evidence is being used?
“The department needs to evaluate and measure outcomes relative to original expectations and investments made to date in the PCEHR against a strategic agenda.” In other words this has not been done!
What an expensive and misguided  farce!
I think it is fair to say Karen and I agree on this!
David.

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