Variable interactions with national helpdesk - what are the channels for feedback that actually gets heard?

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HNZ Digital Services helpdesk: Has anyone here managed to provide feedback that led to a palpable change for the better and how did you go about that feedback to HNZ Digital Services helpdesk & its masters? Particularly keen to hear from clinicians with any success stories. Feel free to stop reading here as what follows is a rant-moan.

Issues just in the last 24h (Northern region - in case it matters):

  1. No notification that a whole category of Pt care documents was suddenly removed from viewing on Regional Clinical Portal in my DHB [using “DHB” deliberately as neighbours up and down the road use a different document type so were not affected]. All Anaesthesia assessments / Care Pathways type documents suddenly became invisible to healthcare staff for ALL patients in a quaternary hospital one fine Friday morning. To be clear they were visible at 3am when I was at work. They became invisible shortly after the working day for normal people started, which points to active work in the back end of Care Pathways and the team working there must have known that the visibility was gone for portal users. Yet no alert from anyone, emailed or otherwise. No timings (e.g. is it likely to be restored by the weekend?). No advice re: use of failover business plan (there is one, nobody at helpdesk seems to know about its existence or location). Nothing. Cue multiple colleagues, including my Clinical Director, messaging on WhatsApp, mostly to clarify if it is “just them”. It is interesting in its own right that 90odd SMOs and registrars default to “it’s just me” when they are suddenly & randomly unable to see something on RCP. Not “this is a system problem and everyone else can’t see something that they should be able to.” Call to helpdesk - response: oh we have been advised this has been resolved (no). No understanding re: effect of the problem and urgency. And took 3(!) agents until the 3rd one finally documented the extent of the problem correctly. Don’t get me started on having to provide my name and phone number and start my story from scratch every single time the phonecall gets disconnected - usually after the agent moves away to investigate. Gently, I actually have work to do which does not involve either being on hold to helpdesk or repeating myself ad nauseam. The only person who could have helped troubleshot this faster in-house had their access removed by higher powers beyond our DHB CEO, without notice (the lack of basic human curtesy there is also astounding). So we only had the helpdesk number for “help”. The minimisation of problems by people who do not understand the implications is phenomenal to the point that you give up trying.
  2. Ability to file a ticket with screenshots via “Kapehu - Service Now” - technically is available but is closed to me in practice. Took a few months to discover that it’s my specific profile that’s the problem. So, now I have an active ticket since ?February? that my profile is denied access to the correct link in the portal. Ticket still open, nothing done. Intermittently gets closed and then I reactivate it. So current age of ticket is apparently 28 days but actually it’s 28days x3. Our team PA has rechristened the service portal to “Kapehu - Service Never”.
  3. Extremely variable service when you ring - from everything gets “passed on to the relevant team” (and by the time you hear back from anyone with sense you are not at the desktop that has the problem anymore) to the person fixing issues on the fly (amazing!!! … but too little too far between. I would gladly send kudos to these folk so that they get recognised for their skill but I actually have no avenue to do that - any hints, anyone?).
  4. Particular mention of email migration process - assignment of TeWhatuOra addresses seems hotchpotch at best. Lots of grandstanding about which rules will be implemented and then have addresses starting with “firstnameonly”@tewhatuora, “firstinitiallastname” and other permutations. Troubleshooting afterwards is another world of pain - a lot of the time you are told that nothing can be done until all of the account is migrated, not just your email. None of the guides provided work in practice - they do until you complete the steps you are given but after all that, your Teams will still malfunction and your Outlook will likely need profile deletion and re-do by someone with admin rights (not you). You will discover this next time you sign in to the machine you thought was sorted. In short, individual asset(!) sort out is constantly required by most migrated users. The migration appears to be designed for 1 person = 1 machine but that is absolutely not the reality of modern hospital. And vdi/ remote desktop is again a separate entity that may or may not be able to be tackled by the agent you are dealing with. The only things that work fine are Outlook on my own laptop and Outlook on my own phone. DHB devices continue to require multiple troubleshooting phonecalls. Since changing my email I spend half my precious non-clinical time logging in to every single thing separately - open a Word attachment? (sign in), open Excel (sign in), open a link (including a link from this forum - oh no, has to be done in edge browser where edge has you logged in with TeWhatuOra account, not the DHB account one that you are supposed to use). Shared mailbox? - both of mine were renamed with the wrong region prefix. Have tried to pre-empt the second one being migrated to the wrong prefix as spotted incorrect alias yesterday (it is due for migration next week hence alias info only just added) - rang migrations helpdesk => “oh we can’tdo anything until it has been migrated”. Revelation: they can’t do anything after it has been migrated either, just request not to use the mailbox until the problem is sorted by yet another team; previous shared inbox took a couple of weeks to get the prefix fixed.

This sort of thing really does not help the “image” problem that health IT already has. Yes, I can rant all I like about lack of funding and the backroom staff being cut, but that’s a separate topic. The staff who miraculously remain in-house try their hardest to do their job and more, but being kneecapped by higher powers is supremely unhelpful (especially when it is blindingly obvious that the kneecapping is happening because there is a new manager somewhere in the ether who probably hasn’t quite got to grips with the job and hasn’t quite realised the value of inhouse expertise).

To be clear, I do my best to put my money where my mouth is, try not to complain, work with what I have available to me in my organisation, mostly in my own time, and try to generate interest in health IT from clinicians. I personally teach a basic introductory session on health informatics to training registrars in my specialty about matters that would be pertinent to them as SMOs (and yes, put up with the annual complaints of “mwah, it’s not in the exam”) because I honestly believe that if we are to improve anything, more (all) clinicians should have a basic understanding of the health information landscape.

However, the constant lottery of technical support, every bit of improvement requiring a fight and gazillion business cases, reinvention of the wheel with every reshuffle, people (who should know better) telling me with authority that, for example, Businees Admin software will take care of Clinical Audit when only the Business component of that software was bought into and it was never intended to take care of “clinical”, it is just exhausting.

We have so many near-breaches sitting right under the surface. It is terrifying that I am fully aware that clinical audit for a major specialty is being run on google docs with patient identifying info being manually entered and passed around who knows where, complex elective surgery waitlists are being managed via multiple disconnected excel spreadsheets, even the lack of an organisation-wide, let alone national, solution for clinical guidelines makes them so hard to find that actual patient harm is occurring. (Yes I have filed reports to flag problems, I am told “yes we hear you” and “watch this space”, I have now been watching for some years). There is very little I and others in this space can offer in return to make it better and so, like everyone else around me, we close our eyes (because, at the end of the day, audit on google docs is better than no audit) and try to encourage hope that things will improve. Problem is, after yesterday, I think I have lost that hope. Hence my question - is there any avenue to providing feedback that might lead to improvement at least in the communication space of technical support? Or maybe, more saliently, is there any point?

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Hello

You have detailed very clearly issues many clinical staff are finding and there is no clear effective way to escalate these.

My recent issues - nowhere near as serious

I have noticed several significant changes, with the current Helpdesk service, compared to the previous very high standard of service we used to experience. For example, the service used to be exceptional, with troubleshooting and problem-solving often carried out within minutes when needed and tickets typically resolved within the week. More recently, I have observed the following:

  • Wait times when calling can extend for many minutes, and calls are now primarily handled by call centre staff who create tickets without being able to log in and resolve issues directly. No benefit for enduring the wait hoping for a resolution.

  • Some of my tickets have remained unresolved for over 30 days, and I have found myself closing these tickets due to prolonged wait times - clearly, they are not going to get dealt with. I gave up.

  • Triage of calls appears inconsistent; for instance, I reported an NHI issue with two different names across two different digital health platforms, which was initially marked as low priority! Given the recent coverage in the news about NHIs being “shared” and the potential clinical risk and harm that may ensue when this occurs, I would have expected HNZ support desk staff to have been briefed on handling instances of where this is reported and the appropriate response. I needed to follow up to explain the critical clinical risk, after which it was adjusted to medium; fortunately resolved by 5 pm that day. Personally, I would have scored it higher but perhaps there was no clear evidence of impending harm.

I fully understand there are challenges affecting the current service levels. Just looking at the posts here and it is evident the impact of these on service but also those direly affected with job losses. Our family is one also directly affected by redundancy in Health. My intention in reporting the above as I did, taking the time to battle with an incident reporting system not all set up to deal with Data and Digital issues that don’t directly impact a named individual, was to provide constructive feedback to help address these concerns. I note my incident report sits in the system floating unresponded to and picked up by no one - perhaps it will suffer the same fate as some of my IT tickets and languish going nowhere.

I discussed the above with three of my colleagues today and they all equally as concurred. When I suggested that departments might need to quantify the loss of productive time due to waiting for IT issue resolution, they answer was no one has the time to do that but, nor can we afford the disruption of lost time and clinical risk due to the problems not being highlighted.

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I was advised of this contact James Roberts (James.Roberts@TeWhatuOra.govt.nz) - National Service Desk Manager, if anyone needs any escalation support.

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Thank you. Good timing because the report I submitted as advised was rejected because the incident management system is not set up for issues such as this so now I have another avenue to pursue. Your post is very much appreciated.

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I agree with both sentiments. Unfortunately, if we need the first in order to resolve the second because we cannot do otherwise as long as we continue to kneecap affected users by not enabling them to provide feedback constructively and efficiently, I do not see a way forward.

For the first time since Kapehu became a thing in my organisation (last year) I received a random email this morning asking for feedback about Incident [number] - it was one of several incidents I logged on a similar problem since mid March - all were dealt with completely differently (or not dealt with at all). The feedback request email contained only the incident number and title and a link to survey - no date, no detail, no link to the actual incident. I would have to go into Kapehu, search for the incident (both in my adhb Kapehu account AND my tewhatuora Kapehu account as it is never clear which one an incident ends up in /both continue to be used and they are not in any way connected) to find the detail to be able to complete the survey whether it was appropriately resolved. I thought ok, for the purposes of providing constructive feedback, I will invest a little bit of time. However, after all that, when I finally had enough info, and clicked the link to survey, going through authentication etc etc, it brought me to a page which said “You are not authorized or the record is not valid”. Thank you Helpdesk for wasting another 15 minutes of my life, which I cannot get back, and still no feedback to your staff. Hopeless.

This is a particular slap in the face after all the partial migration pain, where about 1/4 of the directorate I work in is now on tewhatuora address and the other 3/4 are not (queue pain of shared mailboxes, calendars, file access, you name it) and yesterday we were told we will be migrating AGAIN, to @healthnz :confounded_face:

Did I miss a memo? Do we have money to burn now to be doing needless migrations? Why on earth have we been doing migrations to tewhatuora up until and including this month(!) if this was on the cards? Not to mention all the wasted hours of letterhead changes and similar pointless, window-dressing work which has nothing to do with actual patient care.

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Thank you Chris for that help. I have forwarded my concerns today and will see what comes of that.

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Let us all remember where this began, and then fell over.

In 2023 there was slow but steady progress towards moving everyone over to tewhatuora.govt.nz as part of the consolidation to a single national health organisation. Interestingly, this is the largest consolidation of Microsoft tenants every attempted - in terms of number of tenants, not raw user numbers.

In early 2024, soon after the Sixth National Government were sworn in, a name change to Health New Zealand | Te Whatu Ora was announced. Many groaned. The latter bit of the name has been systematically de-emphasised since.

As 2024 dragged on, deep cuts to Data & Digital were announced. The low hanging fruit were the consultants working on the migration to tewhatuora.govt.nz, which now proceeded at a snails pace.

This partially completed migration has been deeply painful for all trying to work across the national / local interface. The cost in terms of wasted staff time and stymed collaboration would be jaw dropping (if it could be quantified).

Now, just as the migration finally touched on the half-way point of the journey, we seem to be pivoting to healthnz.govt.nz - shortly before the next election. While shorter as a URL, it does repeat ‘nz’, which is quite unpleasant for those who care about UX.

To an outsider this all seems quite bananas, and to my eye a strong case for removing (or at least limiting) political interference with the health system.

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To an outsider this all seems quite bananas

Quite. So how to limit political influence?

The disgraceful deep cuts to Data & Digital at the most vulnerable moment, cherry topped with the subsequent migration shenanigans, blow out of the water the PR disasters that were/are the ferries contract reversal and the tobacco tax breaks in terms of public harm and thoughtless waste of resources… but had nowhere near the same amount of visibility to the public.

What is worse, even if the visibility to the voter was better, right now there are seemingly no legislative mechanisms for removing/limiting wasteful political influence anyway, right?!

:face_with_raised_eyebrow:

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Well, for a start HiNZ could start advocating for this!

Any @HiNZ-fellows have further thoughts that they can air publicly about this?

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I think some of the frustration in this thread is fair. Poor communication during incidents, variable triage, unresolved tickets, migration pain, and the loss of local expertise are all real issues, and they do affect clinicians directly.

At the same time, I do think the discussion risks focusing mainly on the symptom without fully acknowledging the scale of the underlying complexity.

Health IT did not inherit one clean national environment. It inherited 20+ former DHB environments, each with their own legacy identity and access arrangements, different Active Directory models, different MFA settings, different local domains, and a long tail of systems that often depended on those local configurations to function. Some were on-premise, some were cloud-based, and many local integrations were never designed with national normalisation in mind.

On top of that, there was a major programme of email and tenant consolidation already underway, with a planned move toward more centralised identity and access management. Then naming and domain decisions changed, some users ended up stuck between old and new arrangements, and the organisation has been trying to navigate that while also reducing staff and pushing through other major change such as Windows 11 migration. That does not excuse poor communication, but it does explain why the experience has been so fragmented and painful.

Kāpehu is a good platform, but even a good platform becomes harder to operate when users are spread across multiple domains, multiple identities, partially migrated environments, and inconsistent access pathways. That is not simply a helpdesk failure. It is the accumulated legacy of local optimisation now colliding with national consolidation.

For context, from what i heard from the team involved in the initial rollout of the national ServiceNow instance(Kāpehu), one of the practical challenges was that users belonged to different legacy organisations and identity domains. In some cases, that affected how surveys and feedback workflows behaved, because ServiceNow could treat those users as belonging to separate organisations. From memory, some survey functions were turned off or limited for that reason.

That is also why the “You are not authorized or the record is not valid” message mentioned in this thread is quite believable in a fragmented identity environment. If someone is logged in with one identity, but the incident or survey is tied to another legacy account, the system may default to denying access in order to protect privacy. A technical safety feature can end up producing a very poor user experience.

The same complexity helps explain why Kāpehu can feel like a black hole. In a fragmented environment, triage can become a game of hot potato. A front-line agent may see a ticket about missing documents or access failure, but not have a single clear view of whether the issue sits with a local configuration, a regional application, a national identity sync, or something in between. That does not make the experience any less frustrating for clinicians, but it does help explain why service can feel so variable.

I would also gently suggest that this is not only a systems issue. It is also a process issue. From an IT point of view, it is extremely difficult to deliver resilient, supportable services when every specialty, site, or service believes its workflow is unique enough to justify another exception, another form, another local database, another audit tool, or another workaround.

That is how we end up with shadow IT, Google Docs, spreadsheets, and locally built solutions that may solve an immediate problem but then become unsupported legacy tools for someone else to inherit later. Those workarounds are often understandable, but they are not a sustainable operating model for a national health system. More importantly, they are not just an IT inconvenience. They are a clinical risk. If a system fails on a Friday morning, there needs to be a known, documented, supported fallback, not one that depends on local memory or a single person who is no longer there.

So perhaps the more useful question is not just “how do we get back to the bespoke service some centres used to have?” but “what are we prepared to simplify, standardise, retire, or stop insisting on so that digital teams can focus their effort where it matters most?”

There is plenty that Digital Services could do better, especially around communication, incident handling, and acknowledging clinical impact. But if we want a better future state, it cannot just be framed as IT needing to preserve every local variation with fewer people and more complexity. Clinicians, managers, and digital teams all have a role in reducing unnecessary variation so the environment becomes more supportable, secure, and resilient.

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This is an excellent commentary on the context in which these issues sit.

I had a very interesting conversation with a leader in the IT team yesterday saying very much the same thing and emphasising the impact of the staffing decimation, lack of service transformation to prepare for the structural changes, significant issues in the change management process, a lack of effective communication around what was happening and ongoing communication challenges with regards to where the service has come from, where it is at currently, the huge amount of work that is is being done now to manage and address matters, the goals for where the service needs to be, current performance against service targets and much more. While the details were new to me, and it was enlightening, none of what was explained came as a surprise. It all made sense and explained why the current IT experience it HNZ is what it is. What was described sounded extremely challenging and the toll this has taken on people will have been enormous and I suspect / fear is ongoing.

The difficulty for clinical staff is, that most have no appreciation for the underlying complexity and with the lack of communication it is very hard to not focus on the symptoms and the pain. It’s like being ill and not knowing what the deal is until you go the the doctor, receive an explanation and have a greater understanding of cause and what can be done - this mitigates the pain and anxiety, and one subjectively feels better. I only had this experience regarding the IT issues because I “sought out the Dr.”, not all staff have the time, knowledge or confidence to do this.

The following is absolutely correct and I agree with it; “the more useful question is not just how do we get back to the bespoke service some centres used to have? But what are we prepared to simplify, standardise, retire, or stop insisting on so that digital teams can focus their effort where it matters most?”

The one comment I would make is that when clinical staff express their utter frustration with the level of IT service and compare it to the past, it is not about getting back to the bespoke of the past but an expression of the loss that has been suffered relative to what used to be and the impact of this/ When this is expressed in a vacuum of understanding then it can appear to be a cry to go back to what was. But really what it is, is a cry for understanding and a legitimate expression of need. While I can share the insight I have gained from this forum and the conversation, many many clinicians will not have the benefit of this and that needs to be addressed.

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If it helps I saw that at the beginning TeWhatuOra emails also were setup with 2 other aliases being healthnz and hnz which work if you email to them, slight exception being those that were on teakawhai.

I only presume at some point there is a switch to the default one displayed to avoid the rework and a migrated migration process.

I’ve been keeping and maintaining a list of all known emails/aliases from district to tewhatuora and the healthnz ones if the switch is made including district alias’s, even if the user is not yet migrated to enable a more seamless security for end users, but it hasn’t been smooth sailing.

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Wow! That must be quite some list. Are you sharing it with others within Health NZ - it would seem wise to have a single shared list for this sort of thing, eh?

I didn’t know about the forward planning with alias’s - sounds like that was a very smart move.