Sunday, March 12, 2017

I Am Not Sure We Are Getting The Transparency We Were Promised With The ADHA. Are Things Slipping?

In the last day or so extracts of the February Board Minutes appeared on the ADHA Website.
Here are the links to what we have seen so far.

Board Papers

The intent of the Board is to publish as many Board documents as is feasible. Information and attachments to Board documents that are draft, not finalised or sensitive will not be published. An exception is made for draft material already in the public domain (in this instance the Board Advisory Committee Charters released on 16 September 2016).

Board Meeting 21 February 2017 - Board Papers (Download)

Board Meeting 25 January 2017 - Board Papers (Download)
Board Meeting 15 December 2016 - Board Papers (Download)
Board Meeting 16 November 2016 - Board Papers (Download)
Board Meeting 18 October 2016 - Board Papers (Download)
Here is the overall link:
Browsing this list and the documents themselves raises more than a few issues.
The most obvious of these are the obviously large number of documents that are not being disclosed. There are a huge number of gaps in the item list for each of the meetings!
Next in the documents actually disclosed there are some rather odd items. As an example this from the Feb 21 CEO Report raises more than a few questions:
----- Begin Extract

Improving the culture of the organisation: implementing Organisational Excellence

Our approach to building desired culture is focused on three levels: organisational, divisional and individual. We are building an organisation culture where team members are satisfied and motivated to perform to the best of their abilities. At the divisional level, the highest levels of co-ordination, co-operation, and mutual support need to be in place. Through individual initiative, effective teamwork, and divisional coordination, the Agency will be a high performing organisation.
The culture of the organisation is not where we want it to be. The Organisational Culture Inventory results provided a strong indicator that there are a number of areas which are important to staff that we need to focus on. As an organisation, it is vital we are committed to diversity and transparency. We are developing a dashboard to confirm our commitment to equality and diversity in our workforce. I have been very impressed by the willingness of staff to be open and honest about both the positives and negatives of their experience.
Our divisional workshops are designed to provide a good opportunity to discuss many of the areas of concern.  At an organisational level our focus is on starting to address the below.
  •          Meaningful goal setting;
  •          Building a culture of accountability;
  •          Improving internal communications;
  •          Living values and behaviours; and
  •          Giving recognition
I would like to thank Terence’s team for ensuring all Agency staff and the Executive are supported through this important organisational transformation effort. The Board will be asked in this meeting for their advice on how we implement organisational design to drive a positive performance culture across the Agency.

Workplan delivery

There has been significant progress in the delivery of our 2016/17 workplan and on the priorities agreed by the Board in its last meeting. We have announced a new programme to connect all pharmacies in Australia to the My Health Record. We have made good progress in dialogue with providers of private pathology and radiology services and intend, as per the work plan priorities agreed by the Board in its last meeting, to launch a number of implementations this year to upload reports into the My Health Record. We have also launched an implementation programme for Secure Messaging.
Board members will remain concerned about the capabilities of the new organisation to meet the delivery challenges of the work plan this year and next - and, of course, the potential approval of the Return to Government for My Health Record. Legacy challenges remain real. The Agency has capabilities it does not need and others that it does not have. The Board will discuss management’s proposals for our organisation’s more effective delivery of its workplan in this meeting.
----- End Extract.
Examples are things like “The culture of the organisation is not where we want it to be” leaves one wondering just what is presently not OK.

It also seems that job losses are being strongly hinted at! “Legacy challenges remain real. The Agency has capabilities it does not need and others that it does not have. The Board will discuss management’s proposals for our organisation’s more effective delivery of its workplan in this meeting.”

Additionally the Delivery Report highlights a range of risks – but the Appendix that discloses what is at risk etc. is not provided.

I also wonder just what is meant by the term Return to Government for the myHR? Does this mean that someone is to approve the benefits flowing from the myHR? You would need to be pretty gullible to agree to that I believe.

All in all I have to say I had rather hoped for a good deal more – with the only secrecy being applied to those issues which were personally private or genuinely ‘commercial in confidence’. Mentioning a desire for transparency and then not really delivering is a bit sad. I would hate to see a return back to the bad old NEHTA days – as many apparent insiders in the various comments seem to be suggesting seems to happening at present. Insider comments welcome!



Anonymous said...

I never worked at NEHTA directly but had interactions with it, I honestly can't imagine it being any worse, disorganised, self serving disconnected, mayhem would be my four bullet points. However that said with a new EGM running the organisation excellence I hope we can move from the organisation inning towards humming, whatever that means to an adult workforce.


Anonymous said...

I have been very impressed by the willingness of staff to be open and honest about both the positives and negatives of their experience.

Really, any attempt by peasent staff to provide any feedback, briefing notes etc is blocked by layers of management or his army of assistants. Do not ever propose alternative options or a more holistic view of the problems, dare not get in the way or be ousted.

Anonymous said...

I agree David this seems flippant at best. At least with NEHTA you knew government was insistent on closing down any information to the public via NEHTA.

This caught my eye as seemly out of line with the majority of the narrative, almost if by another author - The Agency has capabilities it does not need and others that it does not have. The Board will discuss management’s proposals for our organisation’s more effective delivery of its workplan in this meeting. Very odd and very emotive IMHO.

I guess it is early days and some might be having a difficult time adjusting to Tim's natural openness approach. Like someone pointed out, it cannot be in the staffs interest to have more than one CEO running about.

Anonymous said...

It also seems that job losses are being strongly hinted at! Well in a way, however you just get hired back under contract to do the same job. I am sure it is simply head count shifting

Anonymous said...

Apart from Tim K who is the officially appointed CEO. .... who else is running around acting as though they are a CEO?

Anonymous said...

I believe you are all omitting the fact that you can keep yourselves highly informed through twitter and the Agency blogs. If you are interested there is a wealth of insight into how one man and his journey of discovery is leading the nation in understanding how Digital Health and more importantly the My Health Record is changing lives.

Anonymous said...

Anon 7:31. Could not agree more, the pictures from the recent "journey" to Alice Springs is very revealing. The bush is always a good indicator.

Anonymous said...

He does rather like to travel - in style.

Dr Ian Colclough said...

In such a hugely politically complex environment the Senior Executive of ADHA are on a hiding to nothing. Their best hope of survival is take on a Mentor capable of acting as an impartial informed sounding board.

Anonymous said...

Re 6.58 pm I doubt wether the Board or the Executive would ever be prepared to engage a mentor who understood the issues and politics because it would be too challenging given their insecurities and limited understandings of the Digital Health market.

Anonymous said...

I am sure they will build an app for that Dr Ian Colclough, probably in VR

john scott said...

Colleagues, Ross Gittins has written another great article that goes some way to helping us understand why we continue to have the MyHR debacle. In this case, he is talking about the Robo-debt stuff-up.

Ross makes the comment:
"Its class consciousness has blinded it to such simple truths as that, while you can always bully the top public servants into covering for you, when you mistreat the servants they stop warning you about the hazards you face and, ultimately, indulge in schadenfreude when you fall over the cliff."

Perhaps the public service has given up warning the government awaiting the time to indulge in schadenfreude when the MyHR finally goes to its grave.

You can find the article at:

Anonymous said...

John, the problem here is it's the public service that comes up with the ideas and sells the ideas to the politicians and then develops the solution when they get buy in from the politicians. Don't blame the politicians they aren't the real culprits.

john scott said...

In regard to Anonymous at 10:17 am

Ideas come from a wide variety of sources, including the public service.

Importantly, ideas travel like memes from one nation to the next and from one public administration to the next.
This has particularly been the case with various incarnations of the 'economy', including: the Information Economy; the Internet Economy; the Digital Economy and the Knowledge Economy.
More recently, we have the 3rd Industrial Revolution or the 4th Industrial Revolution--if you are listening to the World Economic Forum.
We see the same phenomenon with Innovation and Digital Disruption.

Every government and every department has to have an 'Agenda' Plan and be prepared to demonstrate progress on its implementation.

The point here is that we have very few genuine leaders and a posse of followers. It is so much easier 'going with the flow'.

The concept of centralised electronic health records dates back to about 2002/3. And, despite widespread failure of these government-led initiatives around the world, we here in Australia persist.

The real questions are:
1. Does anyone listen to warnings about the appropriateness or otherwise of these various agendas? And, the short answer is NO.
2. Have we the courage to imagine something different and have a go? The answer again would seem a resounding NO.

This is our reality and represents the biggest obstacle to significant reform of our current digital health agenda.

Bernard Robertson-Dunn said...

IMHO, they are always fighting the last war/solving the old problems in the old way.

Medicine and health care are moving into a new era, totally different from those of the past. The future will be all about precision medicine, personal medicine, medical IoT and patent centric health care.

The first fact that should be understood is that health records are different from health data.

Health records can be useful but are neither necessary nor sufficient for heath care. Think emergency departments who have to deal with total unknowns. They have protocols and methods, usually based upon observing and measuring the patient as they present.

What they, and other health care professionals, need most is health data - i.e. measurements of the patent now, not in the past. The past can be useful when diagnosing and treating, but is nowhere near as important as the patient's condition when being treated.

If ADHA doesn't recognise all this in their strategy, they will end up whistling in the dark, wondering why they are failing.

john scott said...

Bernard, I agree with your observations and general commentary.

Health administration is better seen as a battle against limits: limits of capital, limits of time, limits of medical knowledge, limits of people and limits of resources. Most of these are immutable.

One area that does not have limits, however, is the use of knowledge.

What the Commonwealth MAY be interested in is an answer to the question: How can we achieve massive productivity gains in healthcare? Because, absent these gains healthcare costs will continue to balloon out causing greater fiscal angst and leading to harmful decisions.

This is the real money question and it will not be solved using 'old thinking' and 'fighting the last war'. By 'old thinking' I mean using the manufacturing paradigm. By 'fighting the last war' I mean 'focusing on efficiency' as opposed to recruiting and leveraging knowledge.

Finally, while there are all manner of proponents of new technologies, such as AI, Big Data, etc. they will not drive change so much as hinder it. They will do so by diverting leader attention from the real challenges associated with achieving a revolution in the quality of collaboration.

Anonymous said...

AnonymousMarch 13, 2017 8:49 AM. Maybe his next gig will be with trip advisor.

Anonymous said...

A tip from the UK, have a few of you in a forum with Kelsey and ask him the same difficult question. He has a hard time when you go off message and ask something of substance.