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  Reply # 1855358 30-Aug-2017 16:22
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geekiegeek:

 

I would vote for any party that ran on a platform of removing the DHBs and centralizing health. DHBs are just little kingdom building exercises that waste money by replicating services across regions. An example is DHBs choosing different ICT systems from each other so there is no way information can be easily shared and no savings through bulk purchase. Why each DHB needs a full ICT team with their own data centers etc is beyond me for a country of <5 Million.

 

This would also get rid of all of these "elected" board members.

 

 

Whilst it's a good idea in theory, it's not that simple.

 

     

  1. Who will run your nationwide system? The Ministry of Health is pretty much incompetent. If you get a private company to run the data centre, they'll siphon money out of the MoH so fast there'll be a vacuum.
  2. The DHBs aren't kingdom-building exercises; they were set up as part of Roger Douglas's nuttiness in the 1980s; they were supposed to drive costs down by competing with each other for contracts. Hence what had been a slightly coherent system fell into disarray. Getting back to a single unified system will be extremely difficult (i.e. expensive and slow).
  3. The one good thing out of the split-up was that  DHBs could get systems that matched their scale; for example, smaller DHBs don't provide oncology services, so don't need the systems that support that. You would lose those efficiencies (such as they are).
  4. Regionalisation is well underway already, with many DHBs sharing data with others in their region, although not yet nationally (e.g. the big 3 Auckland DHBs have been sharing clinical information for about 10 years). But the regional data centres are (surprisingly?? I don't think so) vastly more expensive than the DHB-based ones.
  5. Most DHBs don't have a "full ICT team". They are run with the minimal amount of staff, and sometimes less.
  6. I don't think NZ is big enough to make a "bulk purchase".
  7. The MoH's eccentricities are a major contributor to the issues that DHBs face (e.g. setting loony targets).
  8. Underfunding (and poor decision-making at DHB/Executive level) has led to corner-cutting and deferred maintenance and understaffing and underinvestment in technology; these chickens are coming home to roost now.
  9. One of the interesting outcomes of the Kaikoura earthquake was the incapacitation of Kaikoura hospital; there were *six* breaks in the fibre between them and Christchurch, where their data centre is. Do you really want the data processing for a major hospital to be done elsewhere?

 

Any party that ran on a platform of removing the DHBs and centralizing health would be serious head-in-the-sand material.

 

 


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  Reply # 1855392 30-Aug-2017 16:46
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scuwp:

I can only assume that despite the current controversy he met all of his clearly defined and measurable KPI's for the term therefore they are legally obligated to remunerate him as per his contract?    



And it's incredibly easy to meet them.

One example: all specialist referrals must be seen in 3 months.

Set up a set of rules where anything deemed not urgent (anything that is not cancer for example could be considered non urgent) is declined specialist review. Problem solved.

These arbitrary performance indicators are amazingly easy to milk and not necessarily helping the public.

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  Reply # 1855398 30-Aug-2017 16:52
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I was involved in one of these "regionalising" endeavours and it was an extremely dysfunctional and expensive exercise that after 3 years had only delivered one application to one DHB out of 6 involved. I worked with the ICT teams of each of those 6 DHBs so I'm not talking without experience here.

 

None of the issues experienced was technical, it was all political and everything is done via committee which is never a good outcome if you want to actually achieve something.

 

How many DHBs do we have nation wide for a population of <5 million? How many board members does that equal? 

 

Imagine if a private company like Spark decided to have a separate board of directors for every region in the country. Madness.





When you live your life on Twitter and Facebook, and are only friends with like minded people on Twitter and Facebook, you are not living in the real world. You are living in a narcissistic echo chamber.

 


My thoughts are my own and are in no way representative of my employer.


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  Reply # 1855401 30-Aug-2017 16:56
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scuwp:

 

I can only assume that despite the current controversy he met all of his clearly defined and measurable KPI's for the term therefore they are legally obligated to remunerate him as per his contract?    

 

 

Probably did.

 

But what about something in the contract about meeting statutory requirements for reporting expenses?  Did the DHB forget about that when negotiating the employment contract with the CE?

 

Very damned surprising that in this day an age any senior public servant would dream of milking their expense account. Career ending I'd have thought - you get publicly named and shamed - not a quiet DCM.


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  Reply # 1855884 31-Aug-2017 12:11
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geekiegeek:

 

I was involved in one of these "regionalising" endeavours and it was an extremely dysfunctional and expensive exercise that after 3 years had only delivered one application to one DHB out of 6 involved. I worked with the ICT teams of each of those 6 DHBs so I'm not talking without experience here.

 

None of the issues experienced was technical, it was all political and everything is done via committee which is never a good outcome if you want to actually achieve something.

 

 

I was probably involved in the same project from the DHB end... it sounds very familiar. I too was appalled at the lack of progress and the cost. From my PoV, it seemed that the project was intent on delivering a perfect solution through infinite analysis and deferred decisionmaking and plentiful meetings, with no-one driving it in any particular direction. 90% of the functionality could have been delivered in 10% of the time for 10% of the cost. You may be interested to know that the second DHB is now on too.

 

I agree that the issues were generally speaking not technical, but were to some extent dictated by the politics, plus the architecture. For example, a shared record where each data item is owned by whoever uploaded it last is a recipe for disaster. AFAIK, that still hasn't been resolved, even now that there *are* two "owners" on board. Until it is resolved, it will continue to be a source of pain.

 

And I agree that those committees are a large part of the problem. I've never known anywhere that has a more CYA culture than here. And committees guarding their turf, so that no one can make a decision without them. A basic rubber-stamp decision took me a *year* to get agreed. There seems to be a total disconnect between the pronouncements of DHB CEOs and the workers. Money seems to be poured into pet projects of dubious value. My feeling is that erasing the entire senior management teams of at least 6 DHBs, and also cutting a wide swathe through MoH, would result in a large saving in salaries and a big increase in productivity.

 

 

How many DHBs do we have nation wide for a population of <5 million? How many board members does that equal? 

 

Imagine if a private company like Spark decided to have a separate board of directors for every region in the country. Madness.

 

 

 

The Health industry is somewhat bigger than Spark; thousands of people work at each hospital. And these are Public Service entities, not a private company. As I said, this was a Roger Douglas lunacy; apparently he thought that 23 DHBs with 23*(11 or so) members were a good idea, so there is a legislative requirement for local representation.

 

 


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