A recently leaked recording captured Queensland Health director-general Michael Walsh candidly discussing challenges with the roll-out of new electronic medical records – but also commenting on why public servants find it hard to be so candid in public.
The ABC news report quoted Walsh acknowledging clinical concerns about the integrated electronic medical record (ieMR) implementation, in contrast to the typical stream of relentlessly positive messages from the department and the minister in response to sustained media scrutiny following delays and cost increases.
For example, the mixed findings of a December audit report were really a “big tick” for the project, according to Health Minister Steven Miles, because it found some benefits were being realised. The audit also found the overhaul was proceeding far more slowly and at much, much higher cost than planned, and needed stronger governance and contract management. Miles maintains staff surveys also indicate it’s generally been a great success; but it’s clear the department has been working through patient-safety concerns from some clinicians that have led to the delays.
This contrast between the private and public comments of government representatives is what makes such unexpected recordings interesting, of course, but it’s rare their subjects are also taped reflecting on the pressure to remain unfailingly upbeat in public to avoid negative publicity for the government and their department.
Walsh said while he could talk frankly to clinicians about the “messy” and challenging reality of rolling out the critical digitisation project in an environment where patient safety was the paramount concern, he felt forced into a more “black and white” conversation in the public arena.
“I often get caught into having to speak more positively publicly, because you get put into situations of having to say, ‘The system is going to do this, and the auditor-general said that it’s delivering benefits and blah blah blah.’ And that’s not the reality in our day-to-day — it’s messy. If there are safety issues, that’s paramount and we don’t do it.”
During the taped conversation with colleagues Walsh addressed concerns about software glitches, delays, increased costs and stressed staff, the ABC reported, quickly followed by other outlets. He conceded the online system, which intends to replace paper-based clinical charts and digitise many other aspects of hospital treatment, was “not perfect”.
He also pointed out clinicians at each facility needed a high level of confidence the new system would not compromise patient safety, acknowledging such concerns had delayed the roll-out twice, and adding the department would not pressure clinicians to use the new IT system if they weren’t comfortable with it.
The audit found the cost of the project had been seriously underestimated and the leaked recording also captured discussion of some unexpected costs from replacing computers. The health staff observed the digitisation of clinical processes meant computers became crucial instruments of frontline healthcare, and so had to be very high quality.
January saw the resignation of the department’s eHealth chief executive Richard Ashby, who had been under investigation by the Crime and Corruption Commission. The director-general stressed the allegations concerned a potential undeclared conflict of interest in a separate IT investment that he had suspended and was not part of the ieMR system. The government was already under fire from the opposition. which had already been calling for Ashby to step down over the matter and focusing on his key roles in both projects.
Clean-up gets messy
Later that day the minister addressed the recording, which had hit the news at the crack of dawn. In parliament he tabled an early-morning email he received from Walsh after calling him to work out how to handle the news report.
The email aims to explain how both narratives were true, or at least parts of the truth: that the system replacement was going well, delivering clinical benefits and saving money with generally strong support from most staff, at the same time as being delayed in some hospitals by wary clinicians.
“Before every go live the director-general meets with clinicians to ask them if they believe their hospital is ready to implement the new system or they want to remain with the old, paper based record system while further preparations are made,” Miles told parliament. “If staff or clinicians believe they need more time or training with the system then the go live is rescheduled for when they believe they are ready.”
Opposition leader Deb Frecklington understandably took the free kick and seized on the comments, calling for the ieMR program to be put on hold. “It is very concerning that we have a senior public servant making these statements, these allegations of being told to say one thing in public and another thing behind doors,” she said.
In his missive to the minister, Walsh now had the difficult task of reinforcing the positive message but also explaining the difference between his internal and public statements. Rather than state the obvious fact that all governments expect their officials to keep public statements as positive as possible, he suggested the difference here was mainly the depth of detail and the context.
With hospital staff, he said he could talk in more detail about all the benefits of digitising clinical care information, as well as the bureaucratic challenges of doing so in multiple locations with tens of thousands of workers.
“The change management and training effort is significant and staff work hard to make sure that patient safety is maintained during this transformation. Like all large transformation initiatives, it comes with challenges that the program and all hospital staff manage leading up to and post go-live.
“Responding to these challenges is inspiring to be part of and done using careful planning, but like all human endeavours it can sometimes be messy and it is the dedication, skills and hard work of our Queensland Health staff that has made each of the go-lives successful.”
Walsh also affirmed that neither he nor any other departmental senior executives would order hospital staff to switch on the new system; it’s up to them to make the decision to go live.
“When go-live dates change, which they have, it is fully supported by me, the clinical staff of the hospital and all others involved in the transformation because the program is about making our hospitals safer and providing better health outcomes for patients.”
When asked to speak on the record, on the other hand, the director-general said it was usually to respond to criticism or concerns, so that meant he would naturally try to “balance that concern with the positive achievements of the program” in his response. He denied this meant he was gilding the lily in public.
“I am open, honest and frank in all of these contexts and will continue to support the Digital Hospital transformation because it is making our hospitals safer and delivering better health outcomes for patients.”