First up!
I encourage everyone to visit the “what say you” link and register to consult on the Data and Digital consultation document, which will be available until the 12th of May.
If you’ve previously experienced ‘restructuring’, you may be inclined to cynicism. Don’t do this! We are in the midst of a fundamental shift unlike anything I’ve seen in my 30 years of medicine. There is a strong will for change. Have your say in how we fix the architecture of our currently languishing health care system.
Where am I now?
I am currently on the data and digital road show. We have held 11 different face-to-face meetings, and 6 virtual hui. Each one has been different and each one has fed excellent ideas into the new system.
We are adapting to the feedback. At one of the first meetings, I was asked for my ‘elevator pitch’ for the informatics line within the new structure. Here are my—progressively evolving—thoughts on the topic:
CCIO Informatics elevator pitch
Pae Ora identified two fundamental problems:
- Local optimization getting in the way of global excellence
- Failure to achieve true partnership.
These can only be fixed with new thinking, real change and if we strike a balance between the components of our new system. The establishment of Te Whatu Ora and Te Akai Whai Ora is a huge step in the right direction.
Clearly, the most important component is people: starting with those who together with their whānau are seeking health — and including all of us, across all professions, care settings and varying current levels of digital capability.
Here is where Clinical Informatics comes to the fore, both within and outside Data & Digital. We ease the flow of information, translating and providing context that makes this information meaningful. We do this:
- At all levels we act as the glue between Hospitals and Specialist Services, and Service Improvement and Innovation; and
- Internally between the eight streams of the Data and Digital business unit.
Although you currently see streams called ‘clinical informatics’ and ‘integration’, the things that really matter here are the functions and capabilities of all of the various streams of data and digital, and our ability to pull together virtual teams (or guilds) based on capability, capacity and skills.
This how we can translate national design into regional alignment and ultimately, local tailoring. In other words, we counteract tendencies to adopt a ‘managerial top down approach’ using local knowledge of what works on the ground.
At this point my pitch stops at a floor
I’m supposed to go …
And this is the answer…
That’s not how things work here!
I don’t believe our current, tentative structure will get us where we need to go. There are still missing pieces. There are likely pieces that don’t quite fit. This is precisely why I’m on the roadshow. Why I’m listening and learning and thinking how we can adapt.
It’s easy to cling to the status quo. This won’t get us anywhere. It’s easy to repetitively try things that haven’t worked in the past—hoping this time it will be different. That’s a fixation error. It’s easy to feast on low-hanging fruit, but that also will not get us to the next step in the complex, adaptive pattern we need to weave.
You have given me a number of good ideas and suggestions already—but what will really help is your continuing to provide these. What will help even more is where you explain the thinking behind your suggestions.
The way forward—some foundational ideas
The above might seem just too vague. Here are some more concrete principles for you to criticise:
- Mere belief is not enough. We must tease out wants from needs. We need to review both, but if we try to please everyone, we’ll end up pleasing nobody. We must address needs.
- We have already identified areas of excellent function, but in the past we have failed to translate this excellence across the country. We must fix this mode of failure, and start to grow the good.
- Architecture is important. Especially with modern information technology, there’s a tendency to hope that the data will start speaking, and miraculously transform themselves into coherent, contexual information. This won’t happen. Not only are data mute, but even fancy AI will struggle to put data into place if they have initially been robbed of context. Relationships are as important as ‘data points’.
- Every subdivision of a problem is potentially a silo in the making. The way to prevent this is to start from common ground, and share information, ideas and frustrations as we grow. We need friction to wear away the sharp edges, but we also need the lubrication provided by free flow of information. (This metaphor may need some work :)
- The real enemy is complexity. There is no problem, however complex, that a bit of injudicious fiddling can’t make more complex! Conversely, once we’ve delineated the foundation—and where and how it should be built—a lot of the complexity can be put in its right place.
As New Zealanders, we’ve often been rightly proud of our innovation. But we cannot be backward-looking, focussing on successful past innovation, especially in health care. If we identify solutions that are hard, that should not dissuade us, provided they are also necessary.
If this were easy, others would have done it properly, already. They haven’t. I believe we can.
Have your say
Please comment in this forum. I will read and value your comments. This is, of course, informal communication in a safe, closed forum.
I would also strongly encourage you to give feedback on the official site:
This has many advantages. You can weight comments and discussions by upvoting them, and submit official feedback. You can read a number of the other business units’ consultation documents. The document I’d single out for scrutiny is this one: Service Improvement and Innovation.
Lara
High quality primary care is the foundation of a fair/equitable health system, so needs to be the starting place.