Shedding Light on the eHealth Ontario Scapegoat Scandal

It is so easy to point fingers and judge, isn’t it?  We do it all the time.  Our society is addicted to it.  An accusation or allegation arises that strikes a chord of outrage inside us and we react automatically—intellectually, emotionally, even motor-instinctively—to condemn the accused without even so much as a pause of consideration.  There is a real danger in jumping to conclusions.  We would be much better off taking a step back and considering the bigger picture.  But of course, if you’ve been following this blog at all, you will know I thoroughly believe that most people are unaccustomed to (if not outright incapable of) big-picture thinking.  Still, without doing so, society will often quickly identify, condemn, and come down harshly on a scapegoat, someone conveniently positioned at the apex of a scandal, who ends up carrying the brunt of the blame, perhaps somewhat unfairly.

Let us examine this phenomenon in light of the recent allegations of overspending by Ontario’s eHealth Program.  If you are unfamiliar with the incident, a background on eHealth can be found in a CBC summary report at this link: http://www.cbc.ca/health/story/2009/05/27/f-electronic-health-records.html .  The overspending and non-tendering of contracts “scandal” that emerged this week is summarized here: http://www.cbc.ca/health/story/2009/05/27/ehealth-ontario.html .

Of course, one could make the argument that eHealth Ontario showed some bad judgment.  But remember, in any transaction, it takes two to tango.  I am going to propose we look at the other half of the relationship for a moment: the private sector consultants and service providers who rang up ridiculous bills and then invoiced the government agency without hesitation or, in my opinion, scruples.

There is a long and infamous tradition of individuals and companies vying for the opportunity to suckle at the proverbial government teat.  Like ravenous piglets in a filthy pen, the biggest, most aggressive, and most cunning weasel their way ahead of their kin, driven by their “right” and “duty” to survive and prosper (and then get fat and lazy).  As a taxpayer this is worrisome enough.  As an executive management consultant and social entrepreneur, it is down-right troublesome. 

Where do these people get off charging outrageous sums of money for delivering comparatively little or no real, discernible value?  Sure, they represent private enterprise and in that respect everyone needs to make a living, but why is it as soon as the client signing their invoices is a government body or agency, their fees triple, their expense accounts become like platinum credit cards, and for all intents and purposes they see themselves as having been handed a “Free Turn, Pass ‘GO’, Collect $200” card?  It’s scandals like this one that give consultants and consulting a bad name.

Let’s change direction for a moment.

Have any of these so-called premium consultants created a model for collaboration in healthcare?  Where is it?  Why can’t we see it?  Where did all that money spent on communication consulting go if not to indoctrinate a new way of thinking in the healthcare field?  You cannot expect anyone to start doing something differently unless you can communicate to them the value of doing so; and in the case of healthcare, that means changing the way practitioners—especially doctors and administrators—think about ownership of information, collaboration, and what’s in the best interest of all concerned (no, not even just patients). 

How do I know all this?  Do I have some inside track on the millions of dollars that have been spent on eHealth in Ontario (or other provinces for that matter)?  No, but I did conduct a global webinar for a client a few years ago, the topic of which was healthcare.  The following case study is pulled directly from Chapter one of The Attlas Project, Volume One – SEE the World in a New Light.

Case Study: A Culture of Collaboration in Healthcare

Common Pulsewas established as the online interactive arm of The Commonwealth Advantage.  According to their website:

Recognizing that the Commonwealth’s 53 member countries account for 30% of the world’s population, 40 percent of WTO (World Trade Organization) membership and about 25% of international trade and investment, the Commonwealth Advantage and CATAAlliance have united to increase Canada’s level of economic development, create new trade opportunities and strengthen ties with Commonwealth nations.

(www.commonpulse.com/about.php)

Common Pulse was to focus on running global webinars (web-based seminars) on various topics and issues relevant to member nations.  The inaugural global webinar in 2007 was to “take an inventory of cutting-edge practices in global health care.” (www.commonpulse.com/news.php).  Since many Commonwealth nations have publicly-funded healthcare systems, this was a particularly relevant topic of discussion, one which would span 24 hours as participants from countries throughout the Commonwealth including Canada, the United Kingdom, Pakistan, and Australia joined, participated, and left the webinar.  Commonwealth Advantage was a client of mine at the time and I was asked to facilitate discussions and record minutes, so that some kind of document could be circulated to all participants after the webinar had ended. 

Early into the webinar, it became painfully clear that Commonwealth healthcare directors and administrators were frustrated by the utter lack of collaboration in their field.  The nature of public funding means that competition between different levels, jurisdictions, and functional components is fierce, with only one primary source of revenue: the government.  The result is that each division or “silo” within the healthcare system goes it alone under a veil of inherent distrust and protectionism, lest their efforts at collaboration and efficiency be rewarded with funding cuts rather than greater mileage from available resources.  Regardless, all participants agreed that no model for a culture of collaboration in healthcare existed anyway.  What could be a better challenge and more valuable take-away lesson than that?

For my own sake, I began by asking the participants just what they meant by a “culture of collaboration” in healthcare.  I had already asked the webinar technicians running the event to focus a web cam on the whiteboard in the room where the Canadian contingent had congregated.  After some lengthy discussion we arrived at a definition the participants could agree on:

“A culture of collaboration is defined as a complex, multi-faceted system consisting of semi-independent modules functioning as one by way of a common nucleus containing and communicating a collective vision / goal (life & survival in the environment) derived from a shared blueprint and communicated with a standardized internal / external operating language.”

Now, I began walking the participants in the webinar through what I call the Attlas Process, which is basically a way of collective brainstorming and deconstruction.  We needed an inventory of the essential elements of the healthcare culture today.  “What does the healthcare system look like right now?”  This was a no-brainer, as all the participants were eager to list for me all the components of the healthcare system.  Then the follow-up: what the essential elements of a culture of collaboration in healthcare would be.  “What would your ideal healthcare system look like?”  It was not long before the webinar participants produced a list which included the following elements:

1. Canada Health Act (or counterpart)

2. One “operable” vision / mission and one common “language” for all members of the healthcare system

3. Aggregation of best-practices and progress made to-date in various jurisdictions, silos, etc. made universally available to all parts of the system

4. A spirit of partnership, tolerance, trust, adaptability

5. National, Provincial, Regional Levels

6. Public and Private Sectors

7. Public-Private Partnerships

8. Vendor Support Infrastructure—collaborative connections between functional elements within the healthcare system and beyond it

Clearly such a list is informative, but it is completely lacking in form.  No wonder healthcare administrators had been wrestling with a model of collaboration for decades.  Luckily for them, I didn’t use valuable whiteboard space to make a list.  The participants in the webinar listed the elements of a culture of collaboration in healthcare, while I arranged these elements as shapes and patterns in logical relationship with each other and in no time at all a very familiar and utterly appropriate model began to emerge.  The resulting rough VISUAL AID looked something like the reproduction below.

Now, I simply asked “What does that look like?”  I added the letters “DNA” and “RNA” to the centre circles (the nucleus) and within moments webinar participants in the room and around the world got it.  Gasps of recognition began to chime in.  The diagram on the whiteboard resembled the most fundamental structure of life itself—the living cell.  I proceeded to walk through the basic logic of the model.  The Canada Health Act is like DNA: the blueprint for all activity in the cell.  RNA and protein synthesis transpose information contained in DNA into useable instructions and transports commands to functional solutions throughout the cell (the organelles); a counterpart must be established to do the same for the Canada Health Act.  The vendor support layer is like the cell membrane, regulating inputs and outputs between the healthcare system and the environment.  The final version of the VISUAL AID that was circulated the next day to all webinar participants can be seen below.

The observant will note that I was able to use the webinar’s collective definition of a culture of collaboration as a provisional definition of a living cell.  This immediately connects the needs of healthcare administrators with the natural world’s solution to fulfilling those needs (the model): the structure and nature of a living cell.  Now, governments being what they are and given the relative positions of the participants in the Common Pulse webinar (actual frontline healthcare administrators, not legislators), I cannot say for certain that the exercise has produced measurable real-world results as yet.  The point of this case study is to illustrate the process by which a SEE VISUAL AID approach can reveal an elegant solution that was staring stakeholders in the face the whole time.  One might also see this case study as an exercise in biomimicry—“a new discipline that studies nature’s best ideas and then imitates these designs and processes to solve human problems,” (www.biomimicry.net). While it did not start out that way, the fact that a basic SEE VISUAL AID approach resulted in a biomimetic model is testimony to the versatility and power of the Attlas Process to create real-world solutions to real-world problems using real-world (including natural world) models. 

Again, SEE VISUAL AID benefits all stakeholders, so it is no surprise that the model revealed by the Attlas Process is biomimetic; and if followed, would benefit all stakeholders.  After all:

There is no tree whose branches are foolish enough to fight amongst themselves.

– Native American Wisdom 

SEE VISUAL AID, the Attlas Process, and the Win-Win-Win

As the healthcare case study illustrates, the Attlas Process, using SEE VISUAL AID, is inherently cooperative, inclusive, comprehensive, and open.  It must be if everyone is to benefit from the knowledge contained in the medium, and the medium is to be ideally suited to conceive solutions that benefit everyone. Like so many other examples of visual communications discussed in this chapter, it is designed to transfer knowledge digitally to all relevant stakeholders.  The very structure and function of the Attlas Process and SEE VISUAL AID—the medium and its message—is one of universal empowerment—everyone wins. 

In my experience, no idea is as powerful and enduring as the win-win-win, be it in nature, society, or the private and public sectors. Human beings gravitate toward openness and honesty—clear signs of integrity—for all human beings seek trust and security, particularly where their purchase decisions are concerned.  Just consider the recent consumer backlash against products made in China, thanks to reports of potentially dangerous levels of toxicity, and poor design, quality, etc.  Trust is an inherent part of any enduring human relationship and branding is no exception.  The strength of well-known and trusted brands—and the good reputations of organizations—can quickly be trumped by negative news reports revealing untrustworthy behaviour, in much the same way that even a rock-solid marriage can collapse like a house of cards when one partner discovers the other has been cheating.  A corporation is, more or less, “a person” under the law.  In a very real sense, consumers, investors, partners, affiliates, employees, and whole communities have relationships with corporate citizens.  The list of corporate “cheaters” hiding unseemly behaviour overseas, off their balance sheet, or underground, is long and distinguished, or rather, undistinguished.  If we as human beings recognize that enduring relationships consist of openness, honesty, reciprocity, and balance, why would we expect anything less from our corporations and institutions?  Moreover, why would any organization willingly jeopardize its relationship with its stakeholders through dishonest action: a win-lose scenario?  It’s fitting that corporations are seen as persons under the law, for the reasons behind corporate malfeasance are the same reasons why some human beings cheat, lie, advance at others’ expense, hurt or kill—greed, ambition, fear, etc.  It is fair to say that most of us make a point of avoiding such people. 

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This exercise represented my first and only exposure to this particular “problem” and the solution emerged in a single day.  I will not mention how much (or rather, how little) I charged for my consulting work in assisting in the identification of a model for collaboration in healthcare.  Let’s just say Attlas has a philosophy that reaches across the arbitrary distinction of “for profit” and “not for profit” to expand its definition of “value creation for all” beyond the conventional limited scope to embrace the bigger picture.  When it comes to matters of health, education, and others so clearly in the interests of the people and in the jurisdiction of governments, I believe that government agencies owe it to themselves and their constituents to vet prospective consultants, contractors, companies, and all product and service providers, against a broader yard stick.