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Does the rorting of health statistics mean anything to you? [With poll]

4 July 2012 29

In the wake of the Auditor-General’s very worrying look into widespread falsification of data at Canberra hospital we’ve had a lot of commenters coming out of the woodwork to say it’s really no big deal.

What’s bit of industrial fudging of patient records between friends? So what if the systems in the Emergency Department are less sophisticated than the average pub cash register? And why would we want to root out those responsible for such dishonesty in an area requiring great trust? It’s only taxpayer money being allocated on the basis of these numbers right? Only political points being scored to win elections what’s the big deal?

So rather than let a few noisy commenters dominate we’re going to throw it out to a poll.

Health statistics scandal

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29 Responses to Does the rorting of health statistics mean anything to you? [With poll]
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dungfungus dungfungus 12:48 pm 08 Jul 12

snoopydoc said :

mezza76 said :

snoopydoc said :

Hmmm, everyone seems to have an acute case of missing-the-point-itis…

….
3. The problem is not enough acute hospital beds per capita. Plain and simple.
4. Addressing #3 is vastly more important and useful than whinging about #1.

That’s a nice AMA view of the world. You might want to add hospital diversion programs, early intervention, access block programs, buying capacity in private hospitals where appropriate to free beds… and better efficiency of EDs. Plain and simple huh?

Yes, plain and simple.

ED overcrowding is caused primarily by access block.

Access block is caused by an insufficient number of acute inpatient beds.

All the rest is window dressing. Better preventive health care and more “non-acute” aged care beds, etc. will help. But there is no getting away from the fact that for the forseeable future there will be a requirement for a certain number of acute hospital beds per unit of population, and that ratio is currently not sufficient to meet even average demand, let alone surge capacity.

Fixing the frilly add-ons is nice, but prioritising resource allocation to the most obvious and contributory deficiency of the system is a more sensible approach. Improving the efficiency of your car’s engine by even 1 or 2% is vastly better than buying headlights that are 50% more efficient.

I suggest you do a spot of reading about optimal bed occupancy and flow modelling, catch up with the latest peer-reviewed literature on access block and review the figures for acute beds per 1,000 population and the reduction thereof over the past 10-20 years in Australia.

And for the record I am not a member of the AMA… cheers. 🙂

access block = negative patient outcomes

VicePope VicePope 11:40 am 08 Jul 12

Umm, SnoopyDoc. The stats aren’t just an add-on to doing real work in an accountable public sector. They are the only way the punters (let’s call them voters) and the providers (let’s call them the Government and, by extension, the legislature) can know how things are going and whether the managers are performing competently. You see, they do not commonly have the detailed knowledge about the subject that an expert might have and they are attracted by numbers that tell a story. When the numbers are wrong – deliberately or by mistake – their capacity to assess even what they can is taken away.

As someone who has spent lots of time crawling through the greasy bits of bureaucracy looking for stuff, my impression (underlined) is that Canberra Hospital, and maybe other bits of the system, might be heavily oversupplied with clerks doing work which may not be as productive as some other tasks. But I’d need some numbers and a bit of energetic analysis to assess whether my impression is realistic. My other impression from family use of the ACT health system is that the professional medical staff is extremely competent and responsive, but that impression too might need to be adjusted by some real system-wide information.

snoopydoc snoopydoc 12:30 am 08 Jul 12

mezza76 said :

snoopydoc said :

Hmmm, everyone seems to have an acute case of missing-the-point-itis…

….
3. The problem is not enough acute hospital beds per capita. Plain and simple.
4. Addressing #3 is vastly more important and useful than whinging about #1.

That’s a nice AMA view of the world. You might want to add hospital diversion programs, early intervention, access block programs, buying capacity in private hospitals where appropriate to free beds… and better efficiency of EDs. Plain and simple huh?

Yes, plain and simple.

ED overcrowding is caused primarily by access block.

Access block is caused by an insufficient number of acute inpatient beds.

All the rest is window dressing. Better preventive health care and more “non-acute” aged care beds, etc. will help. But there is no getting away from the fact that for the forseeable future there will be a requirement for a certain number of acute hospital beds per unit of population, and that ratio is currently not sufficient to meet even average demand, let alone surge capacity.

Fixing the frilly add-ons is nice, but prioritising resource allocation to the most obvious and contributory deficiency of the system is a more sensible approach. Improving the efficiency of your car’s engine by even 1 or 2% is vastly better than buying headlights that are 50% more efficient.

I suggest you do a spot of reading about optimal bed occupancy and flow modelling, catch up with the latest peer-reviewed literature on access block and review the figures for acute beds per 1,000 population and the reduction thereof over the past 10-20 years in Australia.

And for the record I am not a member of the AMA… cheers. 🙂

mezza76 mezza76 10:05 pm 07 Jul 12

snoopydoc said :

Hmmm, everyone seems to have an acute case of missing-the-point-itis…

….
3. The problem is not enough acute hospital beds per capita. Plain and simple.
4. Addressing #3 is vastly more important and useful than whinging about #1.

That’s a nice AMA view of the world. You might want to add hospital diversion programs, early intervention, access block programs, buying capacity in private hospitals where appropriate to free beds… and better efficiency of EDs. Plain and simple huh?

snoopydoc snoopydoc 9:34 pm 07 Jul 12

Hmmm, everyone seems to have an acute case of missing-the-point-itis…

1. Dishonest reporting is unethical and unfortunate.
2. The numbers in question (the real ones) are pretty bad.
3. The problem is not enough acute hospital beds per capita. Plain and simple.
4. Addressing #3 is vastly more important and useful than whinging about #1.

housebound housebound 5:44 pm 06 Jul 12

Nylex said :

dungfungus said :

johnboy said :

Yeah but no-one believes him either.

At least he resigned.

Even the hOmocidal idiots who insisted on exploding the Canberra Hospital failed to resign.

But they had to face a coronial inquiry – and then there was talk of someone being charged.

And Kate Carnell resigned as a direct result.

Nylex Nylex 4:42 pm 06 Jul 12

dungfungus said :

johnboy said :

Yeah but no-one believes him either.

At least he resigned.

Even the hOmocidal idiots who insisted on exploding the Canberra Hospital failed to resign.

dungfungus dungfungus 3:31 pm 06 Jul 12

johnboy said :

Yeah but no-one believes him either.

At least he resigned.

dpm dpm 3:19 pm 06 Jul 12

The sad thing is, even with all the fudging, TCH ED was/is still one of the worst in the country:

http://the-riotact.com/its-july-we-must-be-surprised-by-demand-at-the-emergency-department/24873

http://the-riotact.com/myhospitals-website-and-canberra-hospital/33311

http://the-riotact.com/emergency-wait-times-growing-longer-according-to-hanson/56037

http://the-riotact.com/worst-emergency-department-in-the-country/60539

Probably explains why, even with the ‘adjusting’, no financial gain occurred – not that they would have known that in advance when doing the tinkering…..!
As others have said, it’s strange to reward the jurisdictions with no ED waiting probs, and let struggling ones fall further behind….?! You’d think the idea behind health performance monitoring was to improve equity in health – not make it worse?!

Anyway, now we know why a couple of those earlier stories contained ‘good news’ about improvements in waiting times!
e.g. “Despite this considerable increase in presentations, waiting times at our emergency departments improved over the last financial year- with 62.8 percent of all people seen on time over the year, compared with 60.3 percent for the previous year.”….. and

“I’m pleased to see the proportion of Category 3 patients seen on time has risen from 44 to 64 per cent, and the proportion of Category 4 patients has increased from 42 to 57 per cent”….

Whoops. 🙁

dungfungus dungfungus 2:11 pm 06 Jul 12

Nylex said :

Considering the Rhodium thieves barely got a wrist-slap for their crimes, I doubt much will come of this one.

Good observation. The current issue is being blamed on one individual as was the Rhodium fiasco and in both cases the accountable ones (both Chief Ministers as well) will end up squeaky clean.
Just what does the Chief Minister get her fabuolous salary for? Ignorance is bliss.
The boss of Barclays Bank resigned for something that was going on he claims he knew nothing about.

Nylex Nylex 1:11 pm 06 Jul 12

Considering the Rhodium thieves barely got a wrist-slap for their crimes, I doubt much will come of this one.

Jindy Jindy 1:07 pm 06 Jul 12

johnboy said :

5% of the records is a huge amount when you consider they’d only alter the adverse entries.

And indeed for serious cases my understanding is the altered records was closer to 20%

You need to go and read the report,
“Audit estimates that in the latest twelve months for which records have been examined (April 2011 to April 2012), the Canberra Hospital’s ATS Category 3 results (i.e. achievements against the target) were overstated by at least 19 percent, and ATS Category 4 results were overstated by at least 10 percent. This involved changes to at least 5,800 patients records out of total of 43,000 records in one year for these two triage categories.”

The 11700 figure comes from all categories, over 3 years (with over 300k entries per year). And note there is a difference between “overstated” and “altered”.

Anyway, my point was that regardless of the extent of the changes made, the lack of security is a bigger worry. When the auditor can’t identify who has logged in when (or even if they were authorised to do so), what faith can we have that confidential records are secure. If there is a culture of using generic logins then what faith can we have that people who are not accountable don’t have a bit of a poke around in the records just because they can.
If the “executive director of critical care” thinks it is okay to have a security system like this, and it is okay to fiddle with the records, does her attitude infect all the staff working there. How can we believe any assurances from others within the same system that it doesn’t.

Jindy Jindy 12:15 pm 06 Jul 12

The fudging of the numbers worries me a whole lot less than the lack of security identified in the report. When a department in charge of private medical records sees it as normal that they use a generic login (with no limits on who has access through that login) then there are much deeper problems than an alteration to treatment times on less than 5% of the records.

    johnboy johnboy 12:22 pm 06 Jul 12

    5% of the records is a huge amount when you consider they’d only alter the adverse entries.

    And indeed for serious cases my understanding is the altered records was closer to 20%

Jethro Jethro 7:09 am 05 Jul 12

http://www.canberratimes.com.au/act-news/data-scandal-threatens-funds-20120704-21hvg.html

Hospital funding should not be linked to how fast emergency patients are seen. Surely if a hospital is struggling to meet patient demand stripping funding from that hospital is a ridiculous response to its struggles.

cranky cranky 8:21 pm 04 Jul 12

VP@#11

Love it!!!

The fact remains that the system rewards good performance, with hard to earn cash, whilst poor performing systems are denied financial assistance.

Way to go!! 🙁

Those that need the dollars are denied it, and the reverse applies.

Our political overlords have decreed that this should be the way it works. Cannot someone with both a brain and some political clout point out the stupidity of this system?

We have a system which certainly does wonders in the ED. But any additional funding, which would reduce waiting times, depends on the medical personnel performing miracles with the resources given them. I can appreciate the pressure subtly applied to all levels of the ED medical workforce to display dollar earning performance.

Given the leakiness of the ACTPS, I’m sure we will soon be privy to a note from on high to the medical team to ‘give us some good figures’.

Having said that, the whole debacle comes down to a scheme dictated by the Feds, and Govco doing their best to maximise income for health.

Jethro Jethro 7:54 pm 04 Jul 12

davo101 said :

eh_steve said :

Investigations need to be made nation wide I reckon, as by many accounts this sort of practice happens everywhere.

No kidding. Does anyone think this is not happening in every other jurisdiction? Once you tie pay, funding, career progression, etc to a performance metric you create an incentive to game the metric. You can just change the numbers, as done here, or change the way you operate. Giving each patient an aspirin and sending them home would get the average wait time way down (and the throughput would go up because when they come back they’re another patient).

Exactly the same thing is happening with NAPLAN: give the kids the answers, drill them for the test and ignore the rest of the syllabus, tell the dumb kids to stay home on the day of the test, etc.

The Freakonomics guys have dozens of examples where this sort of thing has been tried and the outcomes have not been what the originators had hoped.

+1 – I made a similar point on the other thread.

This fraud is an appalling action and the person/people responsible should be punished.

However, it would be doing little but treating the symptoms of a much wider disease if we stopped there without considering why people feel forced to do things like this. We have such high expectations about the service government service providers will give us, but unless these service providers are funded and staffed appropriately it is not particularly fair on them to impose negative consequences when those expectations aren’t met.

Talk to any nurse who works in ER. They are absolutely run off their feet. They are understaffed and over-worked. Is it any surprise they aren’t meeting unreasonable performance expectations?

VicePope VicePope 7:04 pm 04 Jul 12

It’s pretty well inevitable in the contemporary political management environment. Add a ten minute news cycle to a nervous government and throw in upper managers who are conditioned to provide (possibly through performance agreements) whatever result a panicky Minister or his/her protective phalanx of shortsighted staffers wants. Then factor in that the management’s priorities will percolate down to where actual work is done. The surprise for me is simply that this stuff gets found out so rarely.
The cures would mostly require the insertion of a spine into the relevant Minister and senior managers. The treatment would take effect a great deal quicker if about three-quarters of the Ministerial staffers were directed to work more appropriate to their abilities. Selling used cars, perhaps. Prostitution, maybe. Telemarketing?
Repeat in all portfolios in the ACT and every other jurisdiction.

housebound housebound 6:37 pm 04 Jul 12

Deref said :

Few, if any, of us trust politicians, and with damn good reason.

But we badly need to be able to trust our public servants. The reason that this is such a big honkin’ deal is not the figures themselves – it’s the erosion of public trust in what has to be a trustworthy organisation. Take that away and you’re one of a kind with Indonesia and India. The gods help us all in that case.

String ’em up and dispose of the stinking dead skunk that’s current senior executive structure.

The scary thing is the number of people who think it is ok to be dishonest as long as they were well treated by A&E.

dungfungus dungfungus 6:23 pm 04 Jul 12

eh_steve said :

Investigations need to be made nation wide I reckon, as by many accounts this sort of practice happens everywhere.

The TCH “audit” should now be extended to the Walk In Clinic and the surgery waiting lists.

Woody Mann-Caruso Woody Mann-Caruso 6:11 pm 04 Jul 12

The reason that this is such a big honkin’ deal is not the figures themselves – it’s the erosion of public trust in what has to be a trustworthy organisation.

+11

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