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The "E" Word

Entry 1631, on 2014-02-27 at 19:41:23 (Rating 4, Politics)

As an IT professional (actually I don't like that term because it sounds too pompous and I prefer not to pursue a traditional formal approach to computer support) I am often dismayed at the news of the next example of a seemingly endless line of IT disasters. I have commented on these here in the past, especially the Novopay debacle which just seems to go on and on (I don't believe for an instant that the system is working well yet).

The latest in this long line of misery is a 34 hour outage at our local hospital where their system crashed which stopped all patient records systems, phones, and almost every other automated system. This was shortly after a disaster at the Southern DHB where records were lost after a hardware failure and the failure of two backup and archive systems (really? how would any competent professional allow that to happen?)

The Dunedin Hospital outage meant that some patients were asked to go home to retrieve copies of their own paper records. Can anything get much more embarrassing than that?

A spokesman for the District Health Board said there would be no cost to them; that admissions, including emergencies, were delayed but no one suffered as a result; and that a doctor "wouldn't necessarily" have taken longer to see a patient.

That phrase "wouldn't necessarily" is revealing. Reading between the lines I would say there were definitely delays, and everything seems to take forever to happen at hospitals anyway so even greater delays than usual would be very frustrating.

The system was described as a "quite new system", run by IBM, and was considered fail-safe. So I might wonder if this yet another example of a major company which has made a mess of things. But to be fair I shouldn't judge them too harshly, because if this failure is a single event I think that's OK - new systems do need some time to overcome initial issues - but I will be interested to see if there are any further major problems.

Of course it was no surprise when the issue became political. The opposition claimed the problem was a result of the government's cost cutting of health, and that DHBs were in "survival mode". The prime minister countered this by saying that hospitals have been funded more each year (but he did admit this was not as much as under the previous government) and that before National took over DHBs were $200 million in debt but are now back to surplus as a result of greater efficiency. He also said that we shouldn't read too much into this and that systems will break down from time to time.

I think he has a point: systems do occasionally fail (even my own) and I won't judge IBM until I see if these problems are repeated. But the opposition also has a point. When we hear the dreaded "E" word (efficiency) we know there is something bad happening behind the scenes. When "efficiency" is used by people like the PM it really means cost-cutting, downsizing, and reductions in quality of services. Really that's the only way these "efficiencies" are achieved.

So hospitals are funded more each year which is what we would expect for them just to stay where they are because, after all, the population increases each year and there is also inflation to overcome. So what? Increases mean nothing. Then there is the reduction in debt. Well again so what? Reducing debt by $200 million effectively means that much has gone from the health system. Neither of these are anything to be proud of, I would have thought, and to suggest that cost cutting doesn't affect the quality of health and related services, like IT, is a bit disingenuous.

Just today there was a sign of what is really happening when Dunedin nurses met over having to work double shifts and not being able to take lunch breaks because of staff cuts after funding shortages caused by the PM's "efficiency".

I don't think efficiency in this sense is a good thing at all. We need a new way to measure the quality of outcomes in organisations like hospitals. We must banish the old E word and replace it with a new one: effectiveness. Yeah, I know, that is just as likely to be misused as the current one, but at least it's a new start!


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