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Widespread health statistic rorting considered probable by the Auditor. 11,700 records doctored.

johnboy 4 July 2012 64

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The Auditor-General has announced their report on Emergency Department Performance Information in the wake of the health statistics scandal.

Here are the conclusions:

Hospital records at the Canberra Hospital have been deliberately manipulated to improve overall performance information and reporting of the Canberra Hospital’s Emergency Department.  The very poor controls over the relevant information system means that it is not possible to use information in the system to identify with certainty the person or persons who have made the changes to the hospital records.  Under affirmation, anexecutive at the Canberra Hospital has admitted to making improper changes to hospital records.  While this is the case, Audit considers that it is probable that improper changes to records have been made by other persons.  

There is evidence to indicate that hospital records relating to Emergency Department performance were manipulated between 2009 and early 2012.  It is likely that up to 11,700 records relating to Emergency Department presentations were manipulated during this period.  The records that were manipulated mean that publicly reported information relating to the timeliness of access to the Emergency Department and overall length of stay in the Emergency Department have been inaccurately reported over this period.   

Data manipulation

The executive has admitted to manipulating hospital records initially in 2010 and on a much larger scale throughout 2011 into early 2012.  The executive’s admission of manipulating records does not account for all of the changes that were made to hospital records, where timeliness information was improved.  The executive did not admit to making changes to records in 2009.  Furthermore, changes to hospital records made throughout 2010 and early 2012 are not all accounted for by the executive’s admission.       

The executive’s rationale for manipulating records was that they felt under significant pressure to improve the publicly reported performance information of the Emergency Department.  In this respect, Audit notes that there is a significant and ongoing focus on the timeliness performance of the two Canberra hospitals more broadly, and their emergency departments more specifically.  Audit also notes that the recent National Partnership Agreement between the states and territories and the Commonwealth has placed an additional focus on hospital waiting times, targeting $3.4 billion in investment over the eight years to 2016?17 on hospital improvement.  Of this Commonwealth funding, a comparatively small proportion ($200 million nationally and $3.2 million for the ACT) is directly dependent on improvements to Emergency Department timeliness performance.  There is a considerable lack of attention on qualitative indicators, which may provide a more appropriate and rounded assessment of Emergency Department performance.

Managerial pressure was placed on the executive to improve the performance of the Emergency Department.  This managerial pressure reflects the significant and ongoing focus on the timeliness performance of the Canberra Hospital and the requirements of the National Partnership Agreement.  An organisational change management agenda was also underway at the Canberra Hospital since the restructure of the Health Directorate in early 2011.  The organisational change process underway at the Canberra Hospital sought to achieve improved performance and accountability for performance.   

Organisational change can be challenging and confronting for staff.  In relation to the organisational change that was underway at the Canberra Hospital throughout 2011, one stakeholder commented to Audit:  

    The hospital is very resistant to outsiders coming in, very resistant.  In a way, it’s a very protected community and it has developed from a small regional hospital, you know, the Woden Valley Hospital, to the major tertiary referral centre for the region.  And one of the challenges…is whether the change has happened as it’s needed to for staff to move into that much more professional high-pressure dynamic organisation.

Although managerial pressure was placed on the executive to improve the performance of the Emergency Department, this was not manifested in direct or indirect instruction or guidance to deliberately manipulate hospital records.  Furthermore, there was no direct or indirect instruction by any other person, including the Minister for Health.

Very poor systems and practices

The very poor systems and practices in place in the Canberra Hospital and the Health Directorate for preparing and publicly reporting performance information created the opportunity for persons to manipulate the hospital records.  The Emergency Department’s management information system, which is used to prepare the performance information, has very poor system access and user controls.  There is a lack of governance and administrative accountability for this system, which means that there is no identifiable system owner with responsibility for ensuring the integrity of the system and the appropriateness of its access and user controls.   

The very poor system access and user controls over the Canberra Hospital’s Emergency Department management information system has wider implications beyond the inaccurate reporting of timeliness performance.  There are risks to the privacy and confidentiality of patient information.  The very poor systems and practices also mean that there is a risk that the Health Directorate does not meet the requirements of Principle 4.1 of the Health Records (Privacy and Access) Act 1997 relating to the safekeeping of personal health information.   

Audit notes that the same management information system, albeit a newer version, is used at the Calvary Public Hospital.  There are more effective system access and user controls over the newer system at the Calvary Public Hospital.  Nevertheless, some features of the newer system and its implementation at the Calvary Public Hospital may also give rise to risks relating to the privacy and confidentiality of patient information and the potential manipulation of hospital records to improve timeliness performance reporting.  There is also a risk, albeit to a lesser extent, that Calvary Public Hospital does not meet the requirements of Principle 4.1 of the Health Records (Privacy and Access) Act 1997 relating to the safekeeping of personal health information.

There was also a lack of monitoring, review and assurance of the integrity and accuracy of the Health Directorate’s publicly reported Emergency Department performance information.  Various data validation processes are in place within the Health Directorate, but these processes have not been designed to provide assurance over the integrity and accuracy of publicly reported Emergency Department performance information.   

Audit notes that the current monitoring, review and assurance processes over the publicly reported Emergency Department performance information are not consistent with the apparent importance of the performance information, as demonstrated by the significant Health Directorate management and stakeholder interest.

Commonwealth funding

A comparatively small amount of Commonwealth funding under the recent National Partnership Agreement ($3.2 million over the four years to December 2015) is contingent upon the ACT meeting relevant timeliness targets.   $0.8 million is contingent upon the ACT’s timeliness performance in 2012.  This funding may be at risk, as it appears that the ACT is not meeting its timeliness performance targets.  However, it should be noted that this reward funding may be rolled over and provided in future years up to 2015.   

A response from Andrew Barr is expected after 2 (Chief Minister Gallagher having stood aside from this matter due to a friend of her family’s involvement) and no doubt Jeremy Hanson will not be far behind.


UPDATE 03/07/12 15:41: The Greens are first out of the blocks, calling it fraud but wanting a more wholistic approach and pointing out that KPI obsession inevitably leads to bad management:

“The comprehensive report by the Auditor General into the manipulation of ED data has shown the extent of this manipulation by an ACT Health employee. While the individual is not blameless, the report shows the need to examine the reasons behind their actions,” ACT Greens Health spokesperson, Amanda Bresnan, said.

“This highlights many of our concerns about the impact of the focus purely on ED waiting times on patient safety and risk of fraudulent activity that can create.

“There is a continual focus on ED waiting times and other similar measures by both Labor and the Liberals and also in the media, which leaves out any debate about the quality of care or the outcomes people are receiving.

“The Auditor General’s report released today raises considerable concern that the measure, when used by itself, places patient safety at risk. The report also states that there is a considerable lack of attention on qualitative indicators.


UPDATE 03/07/12 15:45: Andrew Barr has announced that everything is fine:

The Health Directorate has already put in place measures to ensure the integrity of data at the Canberra Hospital, and is already moving to implement longer-term measures to ensure the robustness of data now and into the future.

It is important to remember that the issue relates to the altering of data after the care provided in the Emergency Department, and is not about the level of care provided while in the ED.

The Canberra Hospital’s staff are the best in the country, and the Emergency Department has the highest patient satisfaction rates in the country.


UPDATE 03/07/12 17:18: The Liberals’ Zed Seselja and Jeremy Hanson have taken the time to write a lengthy and damning response which concludes thusly:

“This is Katy Gallagher?s legacy as Minister. Not only has the Auditor General discovered a decade of decline in our emergency department but under Katy Gallagher?s failed leadership, a culture of fear, intimidation, and bullying has led to deception on a massive scale.

“Through the revelations that the health system has gone from the best in Australia to the worst, of revelations of a ten year war in Obstetrics that Katy Gallagher knew was happening, with doctors quitting over bullying, to now find out we have been lied to for years utterly destroys Katy Gallagher?s credibility and calls into question every statement about the health system Katy Gallagher makes.

“The first thing we must do as an Assembly is recall Katy Gallagher to the Estimates Committee and go through what this means for the budget – over $800,000 is already at risk and none of the other data is reliable. An ACT version of a Royal Commission also needs to be called for a full investigation as to what happened and why.

“If we do not get to the bottom of this falsification, these appalling results, Canberrans will be going to the election with nothing but a pack of lies and falsified figures from Katy Gallagher and ACT Labor,” Mr Hanson concluded.


UPDATE 03/07/12 19:28: The ABC’s coverage is worth a look. How convenient that senior health executives have decided it’s too hard to figure out which of their number were involved.


UPDATE 04/07/12 09:52: For posterity’s sake here’s a recording of the Ross Solly interviews this morning with the party leaders.

I particularly enjoyed the Chief Minister saying that it’s too hard to switch users on computer systems in a hurry (thus requiring generic logons). The wrist bands used by bar staff to identify themselves to their tills would seem to be a pretty easy place to start.


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64 Responses to Widespread health statistic rorting considered probable by the Auditor. 11,700 records doctored.
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snoopydoc 12:27 pm 05 Jul 12

gooterz said :

Ian said :

In classic ACT Govt fashion, the name of the executive was accidentally released to the media – [li]http://www.canberratimes.com.au/act-news/pressure-led-to-altering-of-hospital-data-20120703-21fsx.html[/li]

I especially like the Chief Minister’s downplaying of the leak of Kate Jackson’s name, but then absolving her office of any involvement in the stuff up:

I think it’s just a mistake by someone who’s photocopied it and didn’t notice. But it didn’t happen in my office,” Ms Gallagher said

.

Classic Katy!

It likely true if you take it more literally.
“in my office” rather than “in my building” or “by my staff”

The only way to clean this pile of . . . up is to get a liberal in to manage heath and do some cleaning.

Why is a director level person allowed to use a generic login? Sounds like BS to me.

Who does HR at the hospital do they also use a generic login, perhaps it would be more secure to write the waiting times on the windows.. It would be much more transparent!

Also, 11k records take a long time to alter.. When did they have time to do this without it affecting their regular work? Surely more than a handful know. At least the senior people as well as the minister.

15 Seconds for each record, they were probably there for weeks!
So a few $10’s of grand in wages as well as the loss of someone to actually manage the hospital staff.

And some of us who are perhaps a little more practically minded might be wondering if the sum of human happiness might better be served if all of the time, effort and cost of all of the current blame-apportioning, whinging, report-writing, commission-requesting, etc. were funneled into improving resources and services in the emergency department….

Just a thought…

gooterz 7:01 pm 04 Jul 12

Ian said :

In classic ACT Govt fashion, the name of the executive was accidentally released to the media – [li]http://www.canberratimes.com.au/act-news/pressure-led-to-altering-of-hospital-data-20120703-21fsx.html[/li]

I especially like the Chief Minister’s downplaying of the leak of Kate Jackson’s name, but then absolving her office of any involvement in the stuff up:

I think it’s just a mistake by someone who’s photocopied it and didn’t notice. But it didn’t happen in my office,” Ms Gallagher said

.

Classic Katy!

It likely true if you take it more literally.
“in my office” rather than “in my building” or “by my staff”

The only way to clean this pile of . . . up is to get a liberal in to manage heath and do some cleaning.

Why is a director level person allowed to use a generic login? Sounds like BS to me.

Who does HR at the hospital do they also use a generic login, perhaps it would be more secure to write the waiting times on the windows.. It would be much more transparent!

Also, 11k records take a long time to alter.. When did they have time to do this without it affecting their regular work? Surely more than a handful know. At least the senior people as well as the minister.

15 Seconds for each record, they were probably there for weeks!
So a few $10’s of grand in wages as well as the loss of someone to actually manage the hospital staff.

Skidbladnir 2:09 pm 04 Jul 12

Every year ACT Government agencies are required to produce a Report to the Chief Minister, certified as being amongst other requirements:
a) compliant with Annual Reports (Government Agencies) Act 2004, and
b) being an honest and accurate account, compliant with the Chief Minister’s Annual Report Directions, and
c) fraud management and prevention has been undertaken subject to the Integrity Requirements of the Public Sector Management Standards 2006, and
d) being compliant with other legislation related to the relevant Directorate’s reporting.

So now that statements like the below are contestable based on the Auditor’s finding that the Executive Director responsible for these statistics and statements (Division of Critical Care) was cooking the books (and potentially not acting alone)…
Eg:
1) “The Emergency Department continued to meet or exceed the national target for triage category 1 and 2 patients.” (ACT Health 2010-2011 Financial Reports, Pg 127)
2) “In 2010–11 emergency department access block reduced by 4 per cent to 26 per cent from the rate of 30 per cent reported in 2009–10…. This result follows work in both public hospital emergency departments to redesign internal processes to improve patient flow. (Pg 106 of same)
3) “Waiting times for category one, two and five patients either met or exceeded the national
standard waiting times in 2010–11
” (Pg 112 of same)…

Are any Annual Reports and Statements subject to revision\correction by the ACT Health Director-General, if so how many Reports, which sections of those Reports, to what degree are amendments required, when will these corrections be tabled to the Assembly and by whom, will those revisions be tabled personally, and will the Minister responsible be willingly subject to further Assembly questioning if required?

Ian 12:40 pm 04 Jul 12

In classic ACT Govt fashion, the name of the executive was accidentally released to the media – [li]http://www.canberratimes.com.au/act-news/pressure-led-to-altering-of-hospital-data-20120703-21fsx.html[/li]

I especially like the Chief Minister’s downplaying of the leak of Kate Jackson’s name, but then absolving her office of any involvement in the stuff up:

I think it’s just a mistake by someone who’s photocopied it and didn’t notice. But it didn’t happen in my office,” Ms Gallagher said

.

Classic Katy!

As for the stats fudger being a middle manager, hardly. Kate Jackson was an executive director, on the 3rd rung down of the Directorate. Not much more senior does it go. There are only 2 executives above her in the org chart. Obviously the pressure to fix the numbers came from one of those two, or the Minister or minster’s staff.

bigred 11:42 am 04 Jul 12

Doctoring stats, not recording inputs, denying data availability or altering KPIs are ACT Government wide strategies to present the best possible picture. So, we now see mock outrage and a sacrificial offering of a Health executive who is now referred to as “middle manager”.

This place is crying out for an ICAC equivalent. I am not hearing Zed calling for one.

AG Canberra 11:32 am 04 Jul 12

Given hospital waiting times are a key indicator of the health of our health system, and we now know that under the watch of the current toy government this info was fraudulently managed, it seems only right that the Minister stands down. It was her department that allowed the fraud and she was evidently asleep at the wheel.

Or will this be another case of “We take full responsibility” until we actually have to take “full responsibility”.

dungfungus 11:00 am 04 Jul 12

snoopydoc said :

dungfungus said :

fincle said :

Can people just lay off the hospital. Whenever people I know have been there or used the emergency department the staff were great.

That may have been your experiences but I have been there for 7 hours sometimes and when I have made an enquiry I have been told that “my name was called 3 times in the past two hours and there was no response”
I had someone with me last time who did not hear my name called either so I get the idea that this is a ploy to get people to give up and go home and I know a lot who have done just this.
I have also seen people really suffering in the waiting room being displaced in the line by drunks who stagger in after getting beaten up in a fight.
My observations at TCH are that they are overweighted with bureaucrats and lacking in people at the coal face.

Your intimation that ED staff would intentionally “not find someone” in the waiting room in order to increase the number of patients who do not wait to be seen is frankly fairly offensive.

As for being bumped down the queue by beaten-up drunks, yes, that may very well happen if, in the professional opinion of the ED staff, that beaten-up drunk is in more urgent need of assessment and treatment to ensure their well-being and safety than you are at that particular time. The decision-making process does not involve subjective moral judgements, I’m afraid.

Thank you for your view – next time I have to present to TCH ED I will masquerade as a beaten up drunk and get immediate service.
My innuendo stands and it was an employee of TCH who was with me when it happened.

PantsMan 10:30 am 04 Jul 12

Chop71 said :

Refer it to the police. It is fraud.

I hope the employee has to pay back their wage to the ACT government, because they obviously were not doing their job.

…. and seriously, up to 120 changed docs per day, they must have been busy and at no point did the light bulb go off “this must be wrong”? ….. what a muppet

I have referred it to the Feds as defrauding the Commonwealth. Waiting on response.

Chop71 10:26 am 04 Jul 12

Refer it to the police. It is fraud.

I hope the employee has to pay back their wage to the ACT government, because they obviously were not doing their job.

…. and seriously, up to 120 changed docs per day, they must have been busy and at no point did the light bulb go off “this must be wrong”? ….. what a muppet

Antagonist 10:16 am 04 Jul 12

Once upon a time, the first rule of managemen was “EVERYTHING is your fault”. It seems these days that managers are not responsible for anything. Any senior manager involved (including the CM) should be standing in a dole queue this morning. It seems that accountability does not mean the same thing it did 30 years ago.

Danielle Post on WIN news – fkn retard. Worst interview ever. Not even a journalists @rsehole.

johnboy 9:57 am 04 Jul 12

I’ve just added in this morning’s interviews on 666 which shed a bit of extra light.

johnboy 9:49 am 04 Jul 12

it terrifies me so many of you are cool with being lied to.

Micky_P 9:29 am 04 Jul 12

Is Hanson crazy? A public servant changed some numbers in a report. Just fix it and get on with looking after sick people. Why don’t they spend the money on nurses instead.

Thumper 8:19 am 04 Jul 12

Whatever the case, expect plenty more of the same if this mob of muppets gets back in again.

Of course, I have no idea how bad the other mob of muppets will be.

snoopydoc 11:32 pm 03 Jul 12

ThrowawayAccount said :

I-filed said :

Hospital doctor: “There’s no point attempting to find our who else did it, as they were using generic logins”.

Just what does the doctor mean by generic logins? Generic logins to workstations? Generic logins to networks? Generic logins to applications?

I haven’t read the report, but this concerns me greatly….I would really like it if anyone that had access to my medical records or files was personally accountable for that access.

Your electronically stored medical records (optical scans of the actual notes made by the doctors and nurses who see you) are stored in a secure system which is zealously guarded by the Medical Records staff, and the application that accesses those records requires individual, specific logins and has robust access/audit trails built into it. Trying to access a person’s medical record when they’re not actually a patient in the hospital at the time sets off klaxxons, prompts a “Please explain what the hell you’re doing?” query and occasionally triggers the release of hordes of flying monkeys to chase you down…

snoopydoc 11:22 pm 03 Jul 12

johnboy said :

A very good point TA.

Whomever signed off on generic logins should be walking the plank too

EDIS software, the patient tracking and information management system used by every emergency department in Australia, is always, in every one of those departments, generically logged into.

snoopydoc 11:17 pm 03 Jul 12

dungfungus said :

fincle said :

Can people just lay off the hospital. Whenever people I know have been there or used the emergency department the staff were great.

That may have been your experiences but I have been there for 7 hours sometimes and when I have made an enquiry I have been told that “my name was called 3 times in the past two hours and there was no response”
I had someone with me last time who did not hear my name called either so I get the idea that this is a ploy to get people to give up and go home and I know a lot who have done just this.
I have also seen people really suffering in the waiting room being displaced in the line by drunks who stagger in after getting beaten up in a fight.
My observations at TCH are that they are overweighted with bureaucrats and lacking in people at the coal face.

Your intimation that ED staff would intentionally “not find someone” in the waiting room in order to increase the number of patients who do not wait to be seen is frankly fairly offensive.

As for being bumped down the queue by beaten-up drunks, yes, that may very well happen if, in the professional opinion of the ED staff, that beaten-up drunk is in more urgent need of assessment and treatment to ensure their well-being and safety than you are at that particular time. The decision-making process does not involve subjective moral judgements, I’m afraid.

gooterz 8:42 pm 03 Jul 12

What other places still use ‘generic logins’ and dont they have any backups of the original data, would be trivial to match up the times and who was incharge, no doubt the records had times that they were modified and surely they would have done other things that identify them!

I also think in this day and age not having accountability is just as bad as manipulating the data yourself, director should be sacked for having bad policies and bad systems.
Seems like every school has had individual logins for 10 years, why is a hospital so different. Why wasn’t their accounting program fixed up so people couldn’t just change the data.

As for the no impact to patients BS. if there were problems and they would have been identified by the real numbers then that is an impact to patients.

11 Thousand changes each one a voter!

Woody Mann-Caruso 8:02 pm 03 Jul 12

The Canberra Hospital’s staff are the best in the country, and the Emergency Department has the highest patient satisfaction rates in the country

*facepalm*

What do you call institutional falsification of data?

Business as usual in some parts of the APS. You can (1) actually perform, (2) rig your performance indicators so that it looks like (1) without the effort, or you can (3) flat out lie about your performance. (2) is safer but requires some craft. Get away with (3) long enough, though – which is not very long at all, maybe enough to make into the annual report or a press release – and then it’s easier to cover it up and move you on than wear the public shame.

Mr Evil 7:56 pm 03 Jul 12

I think we need to put some perspective on this, and not get too carried away in trying to blame the Chief Minister.

I’d start by mentioning that the Liberals have tried to sneak some party political material on to some pamphlets, and as we all know, that’s a much worse offence! 🙂

Generic logins – let me guess “abc123” or “login”?

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