{"id":2612,"date":"2015-01-26T15:52:38","date_gmt":"2015-01-26T04:52:38","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=2612"},"modified":"2015-01-26T15:52:38","modified_gmt":"2015-01-26T04:52:38","slug":"doh-command-and-control","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=2612","title":{"rendered":"DoH command and control"},"content":{"rendered":"<p>&nbsp;<\/p>\n<blockquote class=\"wp-embedded-content\" data-secret=\"zkP8fthEFf\"><p><a href=\"https:\/\/www.themandarin.com.au\/13933-health-dept-lacks-capability-to-craft-a-coherent-federal-policy\/\">What&#8217;s wrong with Health? Lessons from capability review<\/a><\/p><\/blockquote>\n<p><iframe loading=\"lazy\" class=\"wp-embedded-content\" sandbox=\"allow-scripts\" security=\"restricted\" style=\"position: absolute; clip: rect(1px, 1px, 1px, 1px);\" title=\"&#8220;What&#8217;s wrong with Health? Lessons from capability review&#8221; &#8212; The Mandarin\" src=\"https:\/\/www.themandarin.com.au\/13933-health-dept-lacks-capability-to-craft-a-coherent-federal-policy\/embed\/#?secret=fQnXRYjsKc#?secret=zkP8fthEFf\" data-secret=\"zkP8fthEFf\" width=\"474\" height=\"267\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\"><\/iframe><\/p>\n<h1>What\u2019s wrong with Health? Lessons from capability review<\/h1>\n<hr class=\"prl-grid-divider withshadow\" \/>\n<div class=\"prl-grid withshadow\">\n<div class=\"prl-span-3 prl-entry-meta\">\n<div class=\"hidemobile\">\n<div class=\"prl-article-meta\">\n<h3 class=\"font20px normal\">by<br \/>\n<a href=\"http:\/\/www.themandarin.com.au\/author\/seaston\/\" rel=\"author\">Stephen Easton<\/a><\/h3>\n<p class=\"datetime\">15.12.2014<\/p>\n<p class=\"comments\"><a href=\"http:\/\/www.themandarin.com.au\/13933-health-dept-lacks-capability-to-craft-a-coherent-federal-policy\/?pgnc=1#disqus_thread\"><span class=\"dsq-postid\">comments(<span class=\"commentnumber\">0<\/span>)<\/span><\/a><\/p>\n<\/div>\n<p class=\"prl-article-tags \"><span class=\"tagtitle\">DEPARTMENTS<\/span><a href=\"http:\/\/www.themandarin.com.au\/departments\/department-of-health\/\">Department of Health<\/a><\/p>\n<p class=\"prl-article-tags topborder\"><span class=\"tagtitle\">TAGS<\/span><a href=\"http:\/\/www.themandarin.com.au\/tag\/department-of-health\/\" rel=\"tag\">Department of Health<\/a>, <a href=\"http:\/\/www.themandarin.com.au\/tag\/health-2\/\" rel=\"tag\">health<\/a>, <a href=\"http:\/\/www.themandarin.com.au\/tag\/tom-keating\/\" rel=\"tag\">Tom Keating<\/a><\/p>\n<\/div>\n<div class=\" next-prev left\">\n<ul class=\"prl-list prl-list-line no-bullet next_previous\">\n<li><strong><span class=\"defaulttext\">&lt;<\/span> PREV<\/strong><br \/>\n<a href=\"http:\/\/www.themandarin.com.au\/13877-super-departments-locking-out-issues-sturgess\/\" rel=\"prev\">Government super-departments: efficiencies gained, policy lost?<\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"prl-span-9 prl-span-flip \">\n<div class=\"prl-entry-content clearfix\">\n<div class=\"single-post-thumbnail space-bot\"><img loading=\"lazy\" decoding=\"async\" class=\"attachment- wp-post-image\" src=\"http:\/\/www.themandarin.com.au\/wp-content\/uploads\/2014\/12\/iStock_000005946573_Large.jpg\" alt=\"iStock_000005946573_Large\" width=\"750\" height=\"422\" \/><\/div>\n<div class=\"article-excerpt \">\n<p>The Department of Health has nowhere near the strategic policy capability it needs. While it has a strong track record of delivery, overworked and unappreciated staff need a break.<\/p>\n<\/div>\n<p>The Department of Health is a long way from where it needs to be, according to <a href=\"http:\/\/www.apsc.gov.au\/__data\/assets\/pdf_file\/0013\/40027\/DoH-Capability-Review.pdf\">its recent capability review<\/a>, which found it in dire need of the capacity to produce an overall strategic policy for Australia\u2019s federated health system. That doesn\u2019t come as a surprise to people who understand how the department works.<\/p>\n<p>The process of developing a white paper on reform of the federation, the likelihood of the current fiscally restrained environment continuing and the High Court\u2019s decision on the legitimacy of federally funded school chaplains \u2014 <a href=\"http:\/\/www.claytonutz.com\/publications\/edition\/26_june_2014\/20140626\/where_to_now_for_commonwealth_grants_programs_post-williams_no_2.page\">which could have implications for hospitals<\/a> \u2014 are all listed as factors that presage a need for a transformation of the department and its role. The reviewers say the federation reform process, which progressed on Friday\u00a0with the release of an <a href=\"http:\/\/federation.dpmc.gov.au\/sites\/default\/files\/files\/Health_Issues_Paper%282%29.pdf\">issues paper on roles and responsibilities in health<\/a>, is \u201ca significant opportunity for the department to exercise strategic influence on future health system thinking and strategy\u201d.<\/p>\n<p>The department has been highly dependable when it comes to delivering on complex reforms and projects it has been tasked with, but the Australian Public Service Commission\u2019s review team says its \u201cstrong focus on tactical, transactional and reactive delivery distracts from the development of a proactive, long-term and system-wide strategy\u201d.<\/p>\n<p>Of the 10\u00a0capabilities assessed, two are in urgent need of attention: there is almost nothing in place to motivate Health\u2019s overworked and unappreciated staff, and it lacks an overarching \u201coutcome-focused strategy\u201d. UNSW associate professor of medicine and health policy expert <a href=\"https:\/\/med.unsw.edu.au\/people\/associate-professor-tom-keating\">Dr Tom Keating<\/a>, who has considerable experience working with the department, says the review is \u201ca pretty substantial indictment of the organisation\u201d, but also a valuable tool for its leaders.<\/p>\n<div class=\"pulled-left left\">\u201cI certainly think there is an issue there with overall strategic capacity.\u201d<\/p>\n<div class=\"pullquote__social\"><\/div>\n<\/div>\n<p>\u201cI think it\u2019s a very, very useful review, which I hope the department takes on board and responds to,\u201d he told <em>The Mandarin.<\/em> \u201cI certainly think there is an issue there with overall strategic capacity. They need that, and they also need leadership from government. Government needs to be interested in and be prepared to develop an overall strategic perspective on where they want to take health, and they\u2019re not there now. To be fair, the last government, after their first year, wouldn\u2019t have been anywhere near it either and they put in place processes to get there.\u201d<\/p>\n<p>It was the <a href=\"http:\/\/www.health.gov.au\/internet\/nhhrc\/publishing.nsf\/Content\/home-1\">National Health and Hospitals Reform Commission<\/a>, in which the Health Department was just one contributor, that ushered in the more \u201cwell-integrated overall policy framework\u201d. \u201cFor instance,\u201d said Keating, \u201cthe primary care policy of the last government was very well articulated, put together on the basis of really substantial consultation with the sector, and was highly supported.\u201d He suggests the Coalition\u2019s current lack of a coherent federal health policy might make the task of reforming the department even trickier.<\/p>\n<p>\u201cI suspect these things are quite deep-seated and they\u2019re endemic to the organisation in a way, but some of it may be related to the current situation as far as government is concerned, because the current government doesn\u2019t have a coherent, overall health policy \u2014 it deliberately went to the last election without one \u2014 and now its initiatives are piecemeal, unrelated and pretty incoherent,\u201d said Keating. \u201cSo in a way, it\u2019s not surprising that the department might be the same, but I think the review, while it\u2019s been done within the last 12 months, probably reflects some deeper things within the department; that it\u2019s not well-geared to develop a coherent, overall policy framework.\u201d<\/p>\n<p>The review found a need to \u201cbetter connect sources of evidence across the organisation to support the development of a high-level whole-of-health-system view \u2026 in an increasingly contested policy environment\u201d and that despite the establishment of a Strategic Policy Unit, \u201cpolicy discussions are largely constrained within work silos\u201d. The reviewers comment:<\/p>\n<blockquote><p>\u201cThere is broad acknowledgement that the growing prevalence of chronic disease, continued disparity in health outcomes, increasing citizen expectations and unsustainable long-term rate of growth of government health expenditure are some of the many challenges facing the health system. However, notwithstanding the existence of a Corporate Plan 2014\u201317, the department has not engaged with its authorising environment to help develop a high-level strategy to seek to address these and other systemic issues.\u201d<\/p><\/blockquote>\n<p>Until the review, Health was apparently unaware that government and stakeholders expected it to come up with such an overarching strategic policy:<\/p>\n<blockquote><p>\u201cThe department maintains the belief that policy strategy is not sought by stakeholders or the Government. This view is not supported by evidence gathered as part of this review.\u201d<\/p><\/blockquote>\n<p><a href=\"http:\/\/www.themandarin.com.au\/13933-health-dept-lacks-capability-to-craft-a-coherent-federal-policy\/demand-control-axes\/\" rel=\"attachment wp-att-13940\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-13940\" src=\"http:\/\/www.themandarin.com.au\/wp-content\/uploads\/2014\/12\/demand-control-axes.png\" alt=\"The Department of Health is highlighted. According to the review: &quot;Evidence demonstrates that high demand\u2013low control workplaces face an elevated risk of ill health among employees.&quot;\" width=\"540\" height=\"515\" \/><\/a><\/p>\n<h3>Delivering services at all costs<\/h3>\n<p>On motivation, the review found employees \u201cintrinsically\u201d motivated by their own interest in working at Health, but little else. A very strong track record of delivery has come at a cost. Employees described a \u201cresults over people\u201d culture and there is a widespread belief among the various staff and stakeholders interviewed for the review that it can\u2019t go on this way:<\/p>\n<blockquote><p>\u201cGoing forward, many employees and stakeholders commented that the requirement to deliver at all costs on all commitments is increasingly unsustainable in an environment of declining resources. Employees report that they work long hours and under immense pressure to deliver. This is a workplace health and safety risk.\u201d<\/p><\/blockquote>\n<p>The immense respect commanded by former secretary Jane Halton came through in the process, but there was criticism of the \u201ccommand and control\u201d leadership style in the department she led for 12 years. Interviewees variously described senior leaders as \u201crisk averse, outwardly defensive and internally siloed\u201d. Keating says \u201cyou can see that reflected from the outside\u201d. The review cautions:<\/p>\n<blockquote><p>\u201cWhile this approach may be appropriate in responding to a crisis or national emergency \u2026 its application in day-to-day management has resulted in the disempowerment and poor use of its workforce, reinforced vertical silos, limited corporate ownership and potentially hampered innovation.\u201d<\/p><\/blockquote>\n<p>The reviewers heard that SES staff work extremely long hours, duplicating each other\u2019s work due to inefficient systems and processes. As a consequence, executive level staff are in no hurry to join them in the upper echelon. As well, the report states that \u201cemployees at all levels have overwhelmingly reported that the Executive Leadership Team had zero tolerance for bad news or failure\u201d:<\/p>\n<blockquote><p>\u201cEmployees reported they are fearful of making a mistake or failing to deliver. They report that that this has encouraged a departmental culture of compliance and self-censorship, influencing avoidance behaviours such as the escalation of decisions and a reluctance to report \u2018red lights\u2019.\u201d<\/p><\/blockquote>\n<p>\u201cMy experience of working with the department,\u201d said Keating, \u201cmainly on policy and program review related work, is that it\u2019s populated by a large number of young, highly intelligent, well motivated people, who know next to nothing about health and who move around fairly quickly.\u00a0Down through the body of the organisation, that\u2019s the sort of profile, and then higher in the organisation you\u2019ve got people who tend to have been there a very long period of time, and so can lose that critical perspective on the organisation.<\/p>\n<p>\u201cSo I think that there might be some organisational characteristics that contribute to the failure to identify these things as organisational risk.\u201d<\/p>\n<p>While the capability review process only began in 2011, Keating says the methodology is solid and its results can be relied on.<\/p>\n<p>\u201cWhen you\u2019re in a department, it\u2019s hard to see the broader view,\u201d he added. \u201cAnd one of the striking things for me is that \u2014 I\u2019ve done a lot of work and a lot of my research around the functioning of complex organisations, and the things which are described here, such as an organisational culture which doesn\u2019t sufficiently value people, a lack of overall strategic view, problems in governance, problems around managing risk; these are the hallmarks of large, complex organisations.<\/p>\n<p>\u201cThis is not an unfamiliar thing but it\u2019s so common with large, complex organisations, [that] if you were running one you would expect to have to address these issues. And the interesting thing for me is they seem not to have put in place strategies to address these as risks within their organisational framework.\u201d<\/p>\n<p><strong>More at <em>The Mandarin<\/em>:<\/strong>\u00a0<a href=\"http:\/\/www.themandarin.com.au\/13329-agency-report-cards-health-gs-veterans-affairs-reviewed\/\">Agency report cards: Health, A-G\u2019s, Veterans\u2019 Affairs review<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; What&#8217;s wrong with Health? Lessons from capability review What\u2019s wrong with Health? Lessons from capability review by Stephen Easton 15.12.2014 comments(0) DEPARTMENTSDepartment of Health TAGSDepartment of Health, health, Tom Keating &lt; PREV Government super-departments: efficiencies gained, policy lost? The Department of Health has nowhere near the strategic policy capability it needs. While it has &hellip; <a href=\"https:\/\/blog.panicola.com\/?p=2612\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">DoH command and control<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22,6,3],"tags":[],"class_list":["post-2612","post","type-post","status-publish","format-standard","hentry","category-policy","category-politics","category-rapid-learning-health-systems"],"_links":{"self":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/2612","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2612"}],"version-history":[{"count":1,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/2612\/revisions"}],"predecessor-version":[{"id":2613,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/2612\/revisions\/2613"}],"wp:attachment":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2612"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2612"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2612"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}