The recent ANZSOG (Australian and New Zealand School of Government) report – ‘Today’s Problems, Yesterday’s Toolkit‘, is an interesting read. It describes the dearth of trust that has emerged in this era of “false news” and systemic failure to tackle the big policy decisions facing, not just Australia, but the world. Reporting that fewer than 41 per cent of Australian citizens are satisfied with the way democracy works, a precipitous decline from 86 per cent in 2007, it describes this as a world-wide phenomenon, resulting in the emergence of a crisis for democratic forms of government.
It is obvious, when we look at the competing economic interests around big policy decisions, such as action on climate change, that governments are dealing with very complex issues which have equally complex solutions. But this report claims a major capability gap in our public institutions, resulting in the failure to bring new ideas to implementation. An interesting citation is from the June 2018 report of the Senate Enquiry into Digital Government Services, which found that $708 M was wasted for every Billion spent on IT projects.
I started to think about this issue, in relation to the Australian Health System. We have had some spectacular, costly IT system development failures across our country. When I talk with people about that, the general opinion seems to be that we are poor at both contract specification and governance. But I suspect it is more than that. One might be a fine health service administrator but have grown up in a non-digital world and not really grasp “IT speak” which masks such a wealth of possibility. Is there a need for better “catch-up” education on how such innovation might occur? This is the prime focus of the ANZSOG report.
One OECD study described in the ANZSOG report, gives the core governance innovation skills as:
- Iteration (incremental and experimental development of policies and services)
- Design thinking (around what the client wants, rather than what the public servant assumes they need)
- Digital thinking (fashioning research methods and solutions around computers and computer networks)
- Data and evidence use (data literacy)
- Curiosity and flexible thinking (willingness to try out new ways of working)
- New narratives and co-operation (explaining change in persuasive ways to build support)
- Insurgency (ability to challenge the status quo and work with unusual partners)
These skills might be applied to the many areas in which our old toolkit is failing us. We do have one of the best health systems in the world, but it is under increasing pressure of demographic change such as the ageing population and the burden of chronic disease. New technologies should be helping us, but instead, they focus more and more of the health budget into acute care and away from the community based and social care services that might mitigate some of this increased need.
The never-ending treadmill of overcrowded emergency departments, and the focus on activity-based performance indicators are the bane of the lives of health administrators. Our focus becomes one of “political smoothing”, as we respond to a critical media; our problems are compounded, rather than alleviated in such an environment.
The never-ending treadmill of overcrowded emergency departments, and the focus on activity-based performance indicators are the bane of the lives of health administrators.
I spend a lot of time in my sets, talking about potential solutions to the “ED problem” and very little time talking about how these systemic problems need to be tackled from a wider societal base. There is a disconnect between the acute care system and community-based services, that won’t be fixed with the current approach to measurement and incentives.
This is just part of the problem. Consumer engagement is held up as an important goal, with performance on related criteria examined at every 3rd party accreditation survey. Yet our approaches remain placatory, rather than inclusive. Interested consumers who do participate in our goal setting and performance review tend to come from single interest groups, so we are in effect working with political lobbies, rather than broadly educated and informed consumers with an interest in overall system improvement. If we had the skill set described above, we might better engage consumers in the big, complex systemic issues we have yet to solve.
Meanwhile the digital economy will engage consumers in ways we have not yet contemplated.
Amanda Hagan, speaking at the CEDA State of the Nation 2018, in the session on Empowering consumers in the new economy, described a world in which data availability will empower individual consumers. In her scenario, a person might suffer hip pain and consult with her GP, where she would be provided with information on the specialists available to treat her, including the volumes of procedures they do, their outcomes, the types of prosthetics available, and their success rates. Her Health Fund could provide her with an app, that included the sorts of questions she should ask the specialist to whom she is referred. She would be quoted on all out of pocket expenses. Post-surgery, she might be discharged for home rehab where she would have a monitoring device to ensure her progress. According to Hagan, the technology for this to occur is already available.
Hagan’s scenario brings with it a range of things we might see as problems, such as the decreasing subscription to health funds, privacy issues for both consumers and providers. But it is a good example of how digital platforms, working on smartphones and such devices, might prove empowering for consumers.
Change is coming, whether we like it or not. Best get prepared.