Fails - National Health Strategies/Plans
National health strategies often face significant challenges that can lead to failures and overspending. Here are some key reasons why these strategies frequently run over budget and time:
1. Complexity and Scale: Implementing national health strategies involves coordinating numerous stakeholders, including government agencies, healthcare providers, and the public. The sheer scale and complexity make it challenging to manage effectively.
2. Underestimation of Costs: Initial cost estimates often need to account for all variables, including unexpected expenses and unforeseen complications. This underestimation will lead to budget overruns.
3. Political and Administrative Challenges: Changes in political leadership or priorities can disrupt long-term health plans. Additionally, bureaucratic inefficiencies and lack of coordination among different levels of government can hinder progress.
4. Inadequate Planning and Execution: Poorly designed plans that lack clear objectives, timelines, and accountability measures can lead to implementation issues. Even well-designed plans can only succeed if execution is strong.
5. Resistance to Change: Healthcare systems often resist change due to established practices, vested interests, and cultural factors. Overcoming this resistance can take time and effort.
6. Technological and Infrastructure Limitations: Implementing new technologies and building necessary infrastructure can be more challenging and expensive than anticipated. There may also be a need for more skilled personnel to manage and operate new systems.
8. Funding Issues: Securing consistent and adequate funding is a significant challenge. Economic downturns or shifts in government priorities can lead to funding cuts, impacting the sustainability of health programs.
Meanwhile, more than NZ$330 million ($203 million) set aside for digital health initiatives over the past four years up to 2027-2028 has been returned to this year's budget as savings. This includes NZ$187 million ($115 million) for the Data and Digital Foundations and Innovation" initiative and NZ$144 million ($89 million) for the "Data and Digital Infrastructure and Capability – Enabling Health System Transformation" initiative. Both initiatives aimed to deliver data and digital infrastructure and capability needed to implement health system reforms.
This is a great example of bravery, but another project destined to fail before it even starts.
An interesting article by Dawn O'Shea is in the Pulse.IT - Irish Digital Health published on 6th June 2024,
The imminent HSE Digital Health Strategic Implementation Plan will open up a world of opportunities for technology innovators and vendors, according to the HSE chief information officer, Fran Thompson.
Pulse+IT can reveal that the implementation plan, which is expected to be published later this month, sets out close to 1000 individual digital health projects within 48 initiatives.
The projects have been aligned to the six principles detailed in the national strategy published last month and include plans to develop solutions around telehealth, medical device integration, integrated referral management, patient journey analytics, a mobile ecosystem for front line workers and an open health API framework.
The six new regional health areas (RHAs) established under Slaintecare will be responsible for delivering these initiatives locally and will also devise regional solutions to meet the needs of the local area.
Taking the success I had in Australia with the foundational digital health building blocks, the National Health Services Library (aka the National Health Services Directory), which went National in July 2012 following my success in onboarding various state governments, we start with:-
The Basics - Pharmacies, Hospitals, Emergency depts and General Practitioners, then the Services (Hospitals, in-patient, outpatient, surgery types, etc.) they provide, thus Unifying the Health System in small chunks, showing value in the adoption of the Health Services Library
These are just some examples of "Joining the Dots" in Australia across eight state/territory governments."
Once you have the physical location, you can add data elements galore: physical workforce numbers, e.g. nurses, doctors, etc, beds, surgery numbers, healthcare provider identifiers for interoperability, and the list goes.
And I have previously discussed this approach in this article March 2023 -
Whilst playwright John Heywood was busting out his many proverbs back in the 16th century, we still use some of his most well-known sayings today, including 'the more, the merrier', 'better late than never', and 'Rome wasn't built in a day'.
This is an excellent introduction to developing the most effective foundations for health and social care as a priority. These are a precursor to maintaining sustainable growth to keep pace with the demand for health and social care, especially for our vulnerable communities in a state, country or groups of countries (EU as an example)
Heywood implied that it's really easy to overestimate the importance of your vision of your completed empire and underestimate the importance of the systems, foundations, and bricks you need to build it on.
Would you be able to get the Foundations and Structure in Place?
Do you know where all the various categories of organisations (Hospitals, Pharmacies, Aged Care)and the services each provide are, the OLD YELLOWPAGES, and incorporate public, private and not-for-profit?
This approach can deliver Small QUICK wins, in weeks and months instead of long drawn-out MEGA projects over years, the same with Strategies, which are redundant, the day they are published
Success Stories - who make use of a Services Directory to know where your assets are
It?sounds too good to be true. In the space of just three years, a small country in eastern Europe successfully eliminated waiting times for specialist appointments.
In Macedonia, patients now have an average delay of one day to see a specialist.
At the heart of the transformation was an Australian-Macedonian technology partnership called Sorsix.
The company rolled out a national eHealth system in six months at a cost of less than $A3 million, Milan Arizankoski, the head of the e-Health Directorate in Macedonia, said.
Prior to the implementation of the e-booking system in 2013, patients could wait weeks, and in some cases up to 18 months, for specialist care.
The eHealth system, called Pinga, dramatically decreased waiting times by letting GPs see which specialists had the greatest availability.
GPs could pull up a list of the waiting times for every specialist in Macedonia and could book their patients an appointment directly into the specialist’s calendar.
“Once the system went in, a GP could book you in and know when to schedule a follow up,” Dalibor Frtunik, the head of Sorsix’s Australian division, told The Medical Republic.
Some GPs, specialists and hospitals continued to use their own software, but these systems were fully integrated with the national platform.
“There are more than 100 third-party software applications used by health providers in the Republic of Macedonia and these are all integrated, by law, with the system,” Mr Arizankoski said.
Sorsix also made specialist waiting times available to the public along with real-time data on appointments and prescriptions.
In the space of two years, Macedonia rose from 27th on the Euro Health Consumer Index, which measures the quality of European healthcare systems, to 16th in 2014, beating Spain, Greece, Ireland and Italy. This was the largest rise to be recorded in the history of the index, which began over a decade ago.
Professor Arne Bj?rnberg, who facilitates the Index, attributed Macedonia’s “most remarkable advance” to its real-time e-booking system.
“There has not been any increase in beds or machinery,” Mr Frtunik said. “No doctors have been added. It’s literally just more efficient administration that has doubled the amount of care available at the specialist level.”
Not wanting to be outdone by its neighbour, the Serbian government put out a tender, selecting the bid from Sorsix, and deployed its eHealth platform last year.
“They had four or five failed projects before us. But we did it right. The entire national system was completed for under $A5 million,” Mr Frtunik said.
Following the introduction of Pinga, Serbia, which has a population of seven million, leapt from 30th to 24th place on the Euro Health Consumer Index.
“The concept that eHealth is going to take a long time is garbage,” said Mr Frutnik. “We did a country the size of NSW in six months. There is no reason that cannot be duplicated elsewhere.”
So if Macedonia, a country which had previously had the poorest healthcare system in Europe, could deploy a state-of-the-art eHealth system, surely Australia could do the same?
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DISCLAIMER - I have no association with the organisation running these solutions since July 2012; I am responsible for getting all eight (8) State and Territory governments, the Federal Government and significant national professional health bodies to adopt the Victorian Human Services Directory I previously successfully project managed. It has become a part of the foundational building blocks of digital health infrastructure in Australia, and I assisted with the National Business Case. And a Subject Matter Expert (SME)