Tagged: public policy

We need a Incident Information Management System (IIMS) for Health Care Administration

When something adverse happens in hospital, for example, a patient is given the wrong medication, then we are supposed to log a report in the Incident Information Management System or IIMS. It is especially the case that this system should be used when harm to the patient is the result of the error. This is a good system but under-utilised and poorly designed – nonetheless we should continue to promote it.

We should in fact promote it’s extension to medical administration. If we really want accountability about the health care system, and in particular management of the budget, then we need an incident management system for the administrators. Let’s take the human resources department as one example. I have a potential employee for whom I could offer a job, No offer has been made even though the interview occurred 3 weeks ago. The hold up has been with the HR department and their need for more paperwork, etc, etc…..none of which was communicated as advice prior to the advertisement being released. Overall the whole process has been f’d-up, not to mention slow and expensive. So why shouldn’t I log this to IIMS.

Health care management in the Australian public health system is littered with examples of poor practice for which we should have an IIMS system……this is the way to achieve health care reform.

Local, smocal

So apparently Tony Abbott is blocking the referendum on local government http://www.smh.com.au/opinion/political-news/coalition-delivers-blow-to-local-government-referendums-yes-campaign-20130702-2p8we.html

I’m not sure that I have a problem with this.

Australian Government is built on the notion of subsidiarity. The Oxford English Dictionary defines subsidiarity as the idea that a central authority should have a subsidiary function, performing only those tasks which cannot be performed effectively at a more immediate or local level (ripped totally from Wikipedia).

The Rudd healthcare reforms are underpinned by the principle of subsidiarity and yet the reality is the local health districts (LHDs) control some of the decision making yet in reality the State and Federal governments control the dollars and well…you can’t do healthcare without those dollars…so despite decentralised decision making the control is still centralised.

So if Tony is blocking the referendum…think of it in this context….subsidiarity can cause as many problems as the perceived benefits…..for the KRudds of the world it might just be for appearances not substance.

When policies are too big not to implement: the failure of evidence based policy making

So I attended another administrative meeting today. One of the jobs was to review (& approve) a policy that came from ‘above’. There was a lot of pressure from ‘above’ to implement this policy despite the intention of the Federal Government to support subsidiarity (put simply – local decision making). The fact is that the policy is poor and not-evidence based. Many parties outside our local health district oppose the policy. And in fact our local opponents to the policy could site evidence that it is poor policy. Our ‘local’ decision was to compromise and endorse the policy and produce an in-house business rule to overcome the short-comings of the policy – or, in other words, we’ll endorse it and ignore it. I’ve seen this happen several time before in other guises, for example, yes we endorse the policy but we have no money to implement so we will endorse and do nothing. In the National Standards good governance is the number 1 standard: unfortunately this will be about process rather than outcome. Surely it would be better to reject and develop good policy rather than adapt to bad policy.

The Australian Local Health District Paradox or How Does One Assess LHD Board & CEO Performance

National Health Care Reform, and in fact all of Australian government, is built around the principle of subsidiarity – i.e. that delivery and implementation of services, and decisions concerning services should be made as close to the ‘coalface’ as reasonably possible. This has resulted in the creation of local health districts or LHD. The LHD receive a mixture of State and Federal funding that is predominantly administered through State ministries. The LHD governance consists of a Board and a CEO with his/her executive team.

The remit of the LHD Board is to ensure good management of the district and philosophically the Board must protect, and indeed pursue, the interests of the local community. At inception the CEO were appointed by the States rather than by the Boards and the Chairmanship of the Boards, albeit voluntary, was also essentially at the discretion of the States.

The CEO has in effect two masters – the State Ministry of Health and the Board. The CEO is bound to try and achieve the performance targets set by the State. At the current time these are largely around activity based funding. The CEO and Board and hospitals must bring the budget in on target.

The problem for hospitals and their Boards is that hospitals new improvement, renovation and redevelopment. States tend to do little to cater for recurrent infrastructure related capital expenditure so the LHD must compete politically and make the case why their institutions are more deserving than others (that might be in more politically sensitive electoral seats). The Board has a responsibility to the community it serves to try and advocate for its’ cause. The CEO should support the actions of the Board but must also accommodate the bidding of the State and not cause embarrassment for it.

We must be recognize these issues but also manage them. The Board must not let the the CEO control its’ agenda. The Board must manage the performance of the CEO and be prepared to penalise him/or for failing in either management of the LHD budget or in advocacy for the LHD.