77 replies to this topic

[wyly]

Which is why I have to manually write out my name, my address, my drivers license # etc.

The health card has a magnetic stripe on it, which I guess doesn't work.

healthcards can be stolen would be my guess,stolen ID cards would be handy in the acquisition of drugs or sold to someone not permitted to use it(americans)... other info could confirm your ID...my healthcard has no magnetic strip...does your id have photo?

Interesting. How long has Mrs. Wyly been working in healthcare ?

to the best I can recall 20yrs?

PC ? I don't think that's what it is. Such terms are a sign, to me, that organizations are old, job titles don't get revised etc.

pc-politically correct, my term not our healthcares terminology

I thought I got that from your post above. Anyway, I don't trust the system to fix itself from within. Nothing personal, and nothing against the people who do these jobs (especially Mrs. Wiley) but I haven't seen that that works as well as it could.

mrs wyly is fixing administrative changes introduced by an independent outside source...

The types of changes that are happening in the workplace now are nothing short of revolutionary, and you need to bring in specialists from outside to do it, from my experience.

problem is outside sources don't comprehend the problems that occur in an organizations unlike any other...

No - we were speaking of comparing to the US system, which isn't relevant. Benchmarks, though, are relevant. We don't benchmark against worse systems, we benchmark against our own systems.

yes-it demonstrates where improvements can be made, and verifies they do work and where they don't...

Joe Public has no experience in healthcare administration, but I'm not Joe Public. I work with organizations, including government organizations. All organizations, including my own, naturally erect firewalls against self-reporting, outside inquiry and so on. It's understandable that they do so, and it sometimes makes sense.

An example of where it makes sense is the eHealth scandal. A billion dollar operation was put on hold because of a cup of tea.

You have to build reporting and accountability into the systems. I hope I'm not coming across as blaming front line workers, or even administrators for the problem. The problem is with the public, or the lack of public. We don't pay attention to anything but politics, so we get the system we deserve.

even if you were qualified you are still joe public...if you had an MBA with a number of years experience behind you, you would have basic qualification to do mrs wyly's job but coming from the outside there would still be an enormous learning curve...I don't know of many organizations where private buisness ventures(MD's) run under the same general management as their public co-workers ...it's a highly complex multi-layered organization...

Edited by wyly, 04 November 2011 - 01:46 PM.

[Michael Hardner]

healthcards can be stolen would be my guess,stolen ID cards would be handy in the acquisition of drugs or sold to someone not permitted to use it(americans)... other info could confirm your ID...my healthcard has no magnetic strip...does your id have photo?

Yes, mine has a photo and a magnetic strip.

to the best I can recall 20yrs?

That's great. If I were running a project to re-engineer her workplace, I would greatly value a resource like Mrs. Wiley. When these projects are properly done, people like her are key stakeholders and valued resources.

I imagine that Mrs. Wiley can only do so much, as she would likely run up against organization obstacles and institutional obstacles that would limit the reach of her effectiveness.

It's good to get somebody from outside the industry to look at such things so that they can provider the wider view.

mrs wyly is fixing an administrative changes introduced by an independent outside source...

Just because they're outside sources, doesn't mean they're good. Also, they tend to be managed by folks inside the wall if you get my meaning.

problem is outside sources don't comprehend the problems that occur in an organizations unlike any other...

It's a common joke in my line of business that the first thing out of any customer's mouth is "our business is not like the others out there". It's kind of flippant to laugh at that comment, but there's something true in it. There are aspects of every business that are identical to other businesses but people who work with the same subject matter every day can't see that.

And, again, this work is very difficult. This is why the frustrations build up and you get a wrecking ball like Mr. Harris to come in.

More commonly, a new institution will be created from the ground up to replace existing institutions when technology changes and the ground shifts. Think GM, or the newspaper industry.

yes-it demonstrates where improvements can be made, and verifies they do work and where they don't...

Benchmarking ? Yes. But again, the US system isn't a good model to follow for us, in my opinion.

even if you were qualified you are still joe public...if you had an MBA with a number of years experience behind you, you would have basic qualification to do mrs wyly's job but coming from the outside there would still be an enormous learning curve...

Of course there would. As part of my job, I have to learn how other people work. There's always a lot to learn. Restructuring, though, requires that knowledge plus general knowledge of how systems work.

It's hard.

I don't know of many organizations where private buisness ventures(MD's) run under the same general management as their public co-workers ...it's a highly complex multi-layered organization...

I think many government groups have contractors, vendors and so on. I know it seems complicated, but if the very top levels aren't motivated to shake things up then problems grow as moss does. Bad processes end up being automated, and workarounds become institutionalized.

The question "why is this done ?" isn't asked, in fact it can't be asked because there is no one who can answer it - at least not in one place.

There's a story of a major bank that used to close down its print shop Wednesday afternoons. Eventually someone asked why, and no one knew. Finally an old-timer explained that the shift supervisor used to play the ponies at that time.

There you have it.

[dre]

I believe the article said that costs rose, in real dollars i.e. after taking inflation into account.

Anyway, I don't think you're necessarily wrong - but the real question is "why don't we know this" ?

Right but the way we calculate inflation is utterly bogus. The CPI is based on a basket of common goods and services.

If that basket just had fuel, healthcare, electricty, and college tuition in it... do you really think inflation would be at 3%? More like 8 or 10. But if you put non durable consumer goods in the basket then the number comes down because those things have radically dropped in price. If your basket had flat screen TVs and laptop computers in it... then your CPI would actually show DEFLATION.

Im not saying this is the only factor but this is the main reason why producing ANYTHING is comparatively expensive here.

[wyly]

[quote name='Michael Hardner' date='04 November 2011 - 02:58 PM' timestamp='1320440294' post='726100']
[quote]That's great. If I were running a project to re-engineer her workplace, I would greatly value a resource like Mrs. Wiley. When these projects are properly done, people like her are key stakeholders and valued resources.[/quote]

she was consulted but there is no way any outside advisor can possibly see all the variables involved without working in the system themselves...

[quote]I imagine that Mrs. Wiley can only do so much, as she would likely run up against organization obstacles and institutional obstacles that would limit the reach of her effectiveness.
[/quote]yup exactly, when new outside talent from the corporate world is brought in sparks fly, the corporate world doesn't work like the public world and they have trouble understanding a work culture where profit isn't the number one objective...mrs wyly was in the private sector early in her career and needed to learn how the public sector works, some people never learn to adapt...


and in this business you have private interests (mds) who are paid with public funds but the MDs themselves can have some employees who are paid by themselves and other employees who are publicly paid...


[quote]It's good to get somebody from outside the industry to look at such things so that they can provider the wider view.

Just because they're outside sources, doesn't mean they're good. Also, they tend to be managed by folks inside the wall if you get my meaning.[/quote]that's subjective, the last outside source was giant international firm but for obvious reasons I can't tell you who they were...


[quote]It's a common joke in my line of business that the first thing out of any customer's mouth is "our business is not like the others out there". It's kind of flippant to laugh at that comment, but there's something true in it. There are aspects of every business that are identical to other businesses but people who work with the same subject matter every day can't see that.
[/quote]there will be commonalities of course but there will also be significant differences...


[quote]I think many government groups have contractors, vendors and so on. I know it seems complicated, but if the very top levels aren't motivated to shake things up then problems grow as moss does. Bad processes end up being automated, and workarounds become institutionalized.[/quote]how many of those private contractors have public paid employees working for them?

[quote]The question "why is this done ?" isn't asked, in fact it can't be asked because there is no one who can answer it - at least not in one place.

[/quote]being close to the center of the action I know the questions are being asked but for every solution offered many obstacles can rise up to impede change...

Edited by wyly, 04 November 2011 - 02:48 PM.

[dre]

So... CIHI is in the business of constantly analyzing healthcare statistics. It's commonly stated that boomers will be a problem, but the point is that CIHI (and almost CIHI alone) has DATA, so I would trust them over the common wisdom on this topic.

I agree, but I wanted to point out one quick thing...

"Baby Boomers" are generally considered to be people born during the 1945 to 1965.

So these people arent really that old yet. The oldest ones are still only 65, and many of them are not even 50 yet.

And according to health canada this is the expensive demographic... 65+

About 49.7% of total provincial and territorial government health expenditures in 2000-01 were made for seniors aged 65+.

So even if the baby boomers WERE going to place an increased burden on the system, we would not even know it yet. Lets see the data in ten years once a big chunk of those baby boomers are 65 and older.

[Michael Hardner]

Right but the way we calculate inflation is utterly bogus. The CPI is based on a basket of common goods and services.

In any case, I think that CIHI would have been able to pick that up pretty quickly.

[Michael Hardner]

she was consulted but there is no way any outside advisor can possibly see all the variables involved without working in the system themselves...

Couldn't she tell them ?

They're called consultants because they're supposed to consult.

yup exactly, when new outside talent from the corporate world is brought in sparks fly, the corporate world doesn't work like the public world and they have trouble understanding a work culture where profit isn't the number one objective...mrs wyly was in the private sector early in her career and needed to learn how the public sector works, some people never learn to adapt...

Not sure what this means. Work is work. Work cultures are different - likely more different from practice area to practice area than public to private.

But the sparks shouldn't fly - it's just a matter of them recognizing where the levers are to make change. If the system is too complicated, then it may indeed make sense to start anew.

and in this business you have private interests (mds) who are paid with public funds but the MDs themselves can have some employees who are paid by themselves and other employees who are publicly paid...

Ok.

that's subjective, the last outside source was giant international firm but for obvious reasons I can't tell you who they were...

I work for one of those giant firms, and some firms are better than others.

But... I can tell you from experience that the problems we had in dealing with public institutions were about people working across this jurisdictions unable to get a decision from higher ups - unable to schedule meetings because half a dozen 'directors' would be involved... and so on...

Of course once we got these people involved, they had nothing important to say - they just had to be there to make sure nothing was said that they didn't agree with. Institutional problems like that may required a bulldozer.

It makes me understand why Harris took his approach.

how many of those private contractors have public paid employees working for them?

I don't know - why ? Is that more prevalent in healthcare ?

being close to the center of the action I know the questions are being asked but for every solution offered many obstacles can rise up to impede change...

The example I gave above comes to mind.

Some group or another needs to be involved, but there doesn't seem to be any value added by the directors and high executives of all these groups. Instead, they just impede the ability for any changes to be done. And who calls in the consultants ? These same people !

That's how government works.

[dre]

Couldn't she tell them ?

They're called consultants because they're supposed to consult.



Not sure what this means. Work is work. Work cultures are different - likely more different from practice area to practice area than public to private.

But the sparks shouldn't fly - it's just a matter of them recognizing where the levers are to make change. If the system is too complicated, then it may indeed make sense to start anew.





Ok.



I work for one of those giant firms, and some firms are better than others.

But... I can tell you from experience that the problems we had in dealing with public institutions were about people working across this jurisdictions unable to get a decision from higher ups - unable to schedule meetings because half a dozen 'directors' would be involved... and so on...

Of course once we got these people involved, they had nothing important to say - they just had to be there to make sure nothing was said that they didn't agree with. Institutional problems like that may required a bulldozer.

It makes me understand why Harris took his approach.



I don't know - why ? Is that more prevalent in healthcare ?



The example I gave above comes to mind.

Some group or another needs to be involved, but there doesn't seem to be any value added by the directors and high executives of all these groups. Instead, they just impede the ability for any changes to be done. And who calls in the consultants ? These same people !

That's how government works.

Couldn't she tell them ?

They're called consultants because they're supposed to consult.

It sounds to me like its just not a very well run business. I work for gigantic companies all the time, and the well run companies that use six sigma style management practices have all their processes very well documented and mapped out, so a consultant can come in and get a clear picture of whats going on pretty quickly, and bringing in new workers is relatively easy.

Interestingly enough Iv started doing a lot of ECM work in the last couple of years in the medical industry (Us not Canada), and the way these people handle data and documents is some of the worst stuff Iv ever seen. Their new data is a mess, and they have absolutely no command of their legacy data AT ALL.

[wyly]

Couldn't she tell them ?

They're called consultants because they're supposed to consult.

there is too much info to pass on...

Not sure what this means. Work is work. Work cultures are different - likely more different from practice area to practice area than public to private.

But the sparks shouldn't fly - it's just a matter of them recognizing where the levers are to make change. If the system is too complicated, then it may indeed make sense to start anew.

there you go, it's a very different world than the corporate world...there are politically appointed bosses with political directives, there are hired executives, there are academics, researchers, clinical MDs, public service unions...it's like herding cats...

I work for one of those giant firms, and some firms are better than others.

how do you know yours is better than this one?...maybe it was your firm...

But... I can tell you from experience that the problems we had in dealing with public institutions were about people working across this jurisdictions unable to get a decision from higher ups - unable to schedule meetings because half a dozen 'directors' would be involved... and so on...

a company with thousands of employees is bound to have a half dozen or more directors

Of course once we got these people involved, they had nothing important to say - they just had to be there to make sure nothing was said that they didn't agree with. Institutional problems like that may required a bulldozer.

or they learned from past experience no one really listens to them...

I don't know - why ? Is that more prevalent in healthcare ?

I don't know your the expert you tell me...I've never heard of private contractor having employees who were paid by public funds...

The example I gave above comes to mind.

Some group or another needs to be involved, but there doesn't seem to be any value added by the directors and high executives of all these groups. Instead, they just impede the ability for any changes to be done. And who calls in the consultants ? These same people !

That's how government works.

of course the entire point of this exchange was that you assumed there was no attempt to change because public institution are incapable of change... then there was another assumption that the change didn't work and I never said that...anything new needs to be fine tuned, it's too early to tell how much improvement there will be to the overall day to day operation...

[wyly]

It sounds to me like its just not a very well run business. I work for gigantic companies all the time, and the well run companies that use six sigma style management practices have all their processes very well documented and mapped out, so a consultant can come in and get a clear picture of whats going on pretty quickly, and bringing in new workers is relatively easy.

really how would you know what system they use or that your preferred management practice would work in this situation?

[Interestingly enough Iv started doing a lot of ECM work in the last couple of years in the medical industry (Us not Canada), and the way these people handle data and documents is some of the worst stuff Iv ever seen. Their new data is a mess, and they have absolutely no command of their legacy data AT ALL.

but you just said that the companies you work for use this superior management system...US medical administration is 4 times what canadian administration costs but you claimed "It sounds to me like its just not a very well run business"?...

Edited by wyly, 04 November 2011 - 05:31 PM.

[dre]

really how would you know what system they use or that your preferred management practice would work in this situation?



but you just said that the companies you work for use this superior management system...US medical administration is 4 times what canadian administration costs but you claimed "It sounds to me like its just not a very well run business"?...

No i didnt say that. I said SOME of them have good management practices. Some of them dont. The problems you describe are generally symptoms of poor management, and a lack of documentation.

[Michael Hardner]

It sounds to me like its just not a very well run business. I work for gigantic companies all the time, and the well run companies that use six sigma style management practices have all their processes very well documented and mapped out, so a consultant can come in and get a clear picture of whats going on pretty quickly, and bringing in new workers is relatively easy.

Many large companies don't use six sigma.

Interestingly enough Iv started doing a lot of ECM work in the last couple of years in the medical industry (Us not Canada), and the way these people handle data and documents is some of the worst stuff Iv ever seen. Their new data is a mess, and they have absolutely no command of their legacy data AT ALL.

It's not that surprising to me. I'd be surprised if it were otherwise, actually.

[Michael Hardner]

there is too much info to pass on...

Ok. Well, without knowing the details it's hard to comment further.

there you go, it's a very different world than the corporate world...there are politically appointed bosses with political directives, there are hired executives, there are academics, researchers, clinical MDs, public service unions...it's like herding cats...

Ok. If it's too complex, then it's in everyone's interest to work together to improve it, or the whole thing will be replaced eventually.

how do you know yours is better than this one?...maybe it was your firm...

I made no claim about my firm, or any other specifically.

a company with thousands of employees is bound to have a half dozen or more directors

Yes, and likely more than that.

or they learned from past experience no one really listens to them...

Or nobody asks them. If they're not bought into the change, why would they help it to succeed ?

They have to be included so that they have a stake in it.

I don't know your the expert you tell me...I've never heard of private contractor having employees who were paid by public funds...

Me neither.

of course the entire point of this exchange was that you assumed there was no attempt to change because public institution are incapable of change... then there was another assumption that the change didn't work and I never said that...anything new needs to be fine tuned, it's too early to tell how much improvement there will be to the overall day to day operation...

I don't see it happening anywhere in a significant way. I've heard of a few initiatives but they don't seem to be going anywhere fast: CIHI, eHealth, the organization change to the Ministry of Health to create regional authorities. These initiatives don't seem to have a hold on the public imagination - whether or not they're good or bad ideas.

You've pointed out some of the complexities - and these last ones we've discussed are the most significant. The ways to change them is to start again, or to rework the system from the top, it seems.

The workers, government and public should all submit new representatives to design pilot projects of a new to be developed, to replace the existing system. This system would simplify labour rules, and would operate under simplified legislation, and streamlined costs. I can only suggest this as a shot in the dark, as a 50,000 foot view on what might work.

Maybe if unions government and the public were each represented at 33 1/3 % by creative forward-thinking leaders with a desire to improve things, we might get something interesting.

[wyly]

I don't see it happening anywhere in a significant way. I've heard of a few initiatives but they don't seem to be going anywhere fast: CIHI, eHealth, the organization change to the Ministry of Health to create regional authorities. These initiatives don't seem to have a hold on the public imagination - whether or not they're good or bad ideas.

You've pointed out some of the complexities - and these last ones we've discussed are the most significant. The ways to change them is to start again, or to rework the system from the top, it seems.

The workers, government and public should all submit new representatives to design pilot projects of a new to be developed, to replace the existing system. This system would simplify labour rules, and would operate under simplified legislation, and streamlined costs. I can only suggest this as a shot in the dark, as a 50,000 foot view on what might work.

Maybe if unions government and the public were each represented at 33 1/3 % by creative forward-thinking leaders with a desire to improve things, we might get something interesting.

ooor...just maybe the system isn't as bad as it's made out to be and it works rather well considering the shortage of funds and political interference...not that it can't be fine tuned and tinkered with indefinitely...possibly the common public assumption the government organizations cannot run efficiently is just plain wrong...

[Michael Hardner]

ooor...just maybe the system isn't as bad as it's made out to be and it works rather well considering the shortage of funds and political interference...not that it can't be fine tuned and tinkered with indefinitely...possibly the common public assumption the government organizations cannot run efficiently is just plain wrong...

Well... you've already outlined some of the major impediments to change.