One area of health that Michael Walsh hopes the State Government can pursue further during his tenure as Director-General of Queensland Health is e-health.
This is concerned with the spread of information and communication technologies in health care.
Focusing on the big change
Having written a few articles himself on the topic, it’s safe to say he possesses more than merely a passing interest, believing it will fundamentally change the way health care is delivered.
“Just think about the amount of personal information we can now collect about ourselves to help us make choices, such as all the wearable devices that we’ve got,” he says.
“As we move forward, a lot more care and treatment will be able to be provided in a person’s home rather than having to be provided in a foreign environment like a hospital.”
“With access to videoconferencing, to having equipment in the home that can measure blood glucose, blood pressure, heart rate and so on, medical professionals will be able to provide high-quality care but in an environment that’s more conducive to a person’s healing and getting well.”
As for how such a major investment will be implemented in the bureaucratic public service, Michael stresses the importance of effectively communicating the benefits of e-health in a way that is understandable to the average Queenslander.
For example, the fact that medication errors occur with the use of paper charts is something he believes can be minimised with electronic systems, because the customers will have their identification wristband with the barcode on it.
“A doctor or pharmacist, or the clinician administering the medication can scan the barcode, and be alerted to any allergies or problems that the person is having with other medications,” Michael argues.
“It also allows us to get a lot more data to do analysis about what treatments do and don’t work.”
“As long as it’s of clinical benefit and we’re communicating that clearly, and people can see that then I think we can keep up the momentum.”
Michael admits he can’t implement an industry-wide digital transformation all on his own.
Supplier partnerships have become increasingly embedded into the day-to-day practice in hospitals right across Queensland.
For example, Queensland Health relies on Cerner’s electronic medical record system so it can provide information to patients in real time.
And it doesn’t matter whether the doctor is in one of the 16 hospital and health services as part of Queensland Health; they can have access to any changes in information or activity that has occurred in some other hospital.
“It’s also able to support clinicians with decision support around contraindications for medications, and alerts for people who may have reactions to particular drugs or allergies.”
“But you have to have it up and running the whole time,” explains Michael.
“Rolling that out is an enormous change program because it’s changing a culture of people using pen and paper to using electronics and we can only do that with companies like Cerner and DXC.”
“If we take the fact that we’re reliant on our network being available, up and running all day, every day, and that our data centres and our computers, and the mobile devices people use are available, then these supplier partnerships are actually critical for that to occur.”
“We rely on them having robust and reliable systems to deliver that.”
The benefits of e-health can stretch to the whole notion of genomics, or personalised medicine, according to Michael.
Queensland Health’s work with Siemens Healthineers, a company with expertise in diagnostics and related equipment, is allowing it to progressively start utilising some of the information coming out of genome mapping.
Michael says, as a result, it is able to personalise an individual patient’s treatment path. “We work closely with all our partners in order to progress these reforms.”
“Without them investing in research and development and pushing the boundaries of technology, we wouldn’t be able to apply these in a clinical setting to benefit people.”
Born and bred in Western Australia, Michael moved to Australia’s east coast in 1995.
He completed his first degree in science at the University of Western Australia, majoring in science and human movement, before becoming a high school maths teacher.
“I did that for three years and I enjoyed it. Back then I was very idealistic. One of the kids who I was teaching had some really challenging social circumstances.”
The Queensland Health strategy
- Supporting Queenslanders to be healthier
- Enabling safe, quality services
- Equitable health outcomes
- High performance
- Dynamic policy leadership
- Broad engagement with partners
- Engaged and productive workforce
After his stint in teaching, Michael decided he wanted more challenge in his life and became a psychologist. Initially, he worked in youth services, doing some charity work to help homeless youth before moving to services to fight drug and alcohol misuse.
Despite witnessing the hardships faced by the people he was helping, Michael found the work very fulfilling.
“As I worked there, I progressed into management and became a team leader and then managed a service,” he recalls.
“I really enjoyed the opportunity to create a work environment that brings out the best in the people in an organisation so that they can do their best for the people who receive the services.”
So how does someone who started their career studying teaching on the other side of the country end up in charge of the Sunshine State’s entire health system? To Michael, the progression is not as far-fetched as it may seem.
Through psychology understanding people’s behaviour and actions
He points to his psychology background for developing an ability to form different frameworks to view and understand people’s behaviour and actions.
Michael also believes framing problems from a psychological standpoint has solidified his view that there’s usually never a single answer to a problem and that it needs to be looked at through a number of different lenses in order to identify a successful solution that people can back you on.
“To be successful, you have to be able to work with people around their different perspectives in order to identify ways of going forward,” he advises.
“The other thing I’ve definitely learned is that a good, or even an amazing, idea isn’t necessarily going to succeed on its own.”
“You have to put in the work to communicate that idea and allow people to proffer their own ideas for things to be successful.”
“A good, or even an amazing, idea isn’t necessarily going to succeed on its own. You have to put in the work to communicate that idea.”
“I can also say that lesson has also come from my past, teaching maths. You can stand there and talk about algebraic equations, but unless you can make that relevant and within a framework that the people you’re teaching can understand, it’s actually not going to be useful or make any difference to them.”
Understanding other people’s perspectives was something Michael most certainly had to do when the government under former premier Peter Beattie worked on creating a new payroll and rostering system for Queensland Health.
‘A fair day’s pay for a fair day’s work’
When the system went live in 2010, nearly 78,000 staff were either underpaid or not paid at all.
Efforts to repair the system set the Queensland Government back A$1.2 billion over the following eight years.
A Payroll System Commission of Inquiry was established in 2012, the accompanying report handed down the next year.
Michael was Deputy Director-General when the payroll system was implemented, and had been tasked with stepping up and fixing the issue.
He found that people would accept that a mistake on such a massive scale could not be fixed overnight.
“They wanted to know that you were genuine, you were focused, you were working as hard as you could, and that you were open about what was good and bad. In other words, what was working, what you were doing, how things were improving or not improving.”
“It makes you realise that in leadership positions, people actually want to have confidence in you as an individual, not just in terms of skills and expertise but in what you bring in terms of commitment and your willingness to focus on what’s important.”
“People actually want to have confidence in you as an individual, not just in terms of skills and expertise.”
Steadying a ship through such a difficult time for Queensland Health is something Michael calls “probably the most challenging and demanding role I’ve ever undertaken”, describing the experience as “incredibly humbling”.
“Because you’re dealing with some very core fundamentals, and ‘a fair day’s pay for a fair day’s work’ is a fundamental principle of how our community operates and how we remain stable as a community.”
“When that principle is broken, in other words, when people feel they’ve done a fair day’s work but didn’t get a fair day’s pay, you’re dealing with very strong emotions and feelings.”
That hit hardest for Michael when he faced a forum of around 500 people during the scandal’s early days. In his recollection, they were probably the most draining two hours of his life.
“You’re in a situation where your credibility as a person is being judged, not just your capabilities.”
“They want to know whether they can trust you, not just whether you’re doing your job well.”
“There was a lot of emotion, people were angry, upset and crying, and you’re just standing there having to deal with it all,” he recounts.
As for whether the issue has been resolved once and for all, Michael says the payroll system has stabilised and, while there are still a few adjustments that need to be made, they’re not dissimilar to adjustments that other organisations make on a daily basis.
Unlike those organisations, however, Queensland Health has 90,000 people working around the clock, and, being a government organisation, it faces a constant high level of scrutiny.
“Without simplifying the problem too much but also without making it too complicated, when you think about getting paid, there’s the actual computer system that does all the calculations and so forth, and then there are the processes sitting around that to get the information into that system,” he explains.
“It would be safe to say that the technology is as good as you can get now. It’s been upgraded. It’s contemporary.”
“It delivers the pay each fortnight, but there’s always the issue of, for instance, whether the information about the shift you actually worked has gone into the system.”
“The system pays you accurately in relation to what it knows, but if you were down to do a day shift and you’d changed it to a night shift and you didn’t get the penalty rate, then you would rightly feel that you’ve been underpaid.”
“The system paid you correctly on what it knew. It’s just that the process sitting around it hadn’t got the information in.”
Now in 2018, Michael is back at the top rung of Queensland’s healthcare system, unfazed by whoever controls the reins of power at George Street and with clear air to pursue his e-health vision.
Ever the professional public servant, he thinks the department’s purpose is to implement the policies of the government of the day.
Michael’s four-point approach to leadership
Ever the health enthusiast, Michael talks about how he stays an effective leader through the analogy of personal training.
- Commit to others
- Understand the environment
- Support when times are tough
- Be aware of people acting against their best interests
“If you’re out there looking for a personal trainer, the first thing you would want is for them to be as committed to your success as you are. The trainer, in turn, needs to understand what success is for that person.”
“There are trainers who say, ‘I want you to do 10 pushups’, or ‘10 more burpees and crunches’, or ‘run around the block and skip’. You then start thinking, ‘Well they’re not actually working that hard. I’m the one working hard’. What you want your personal trainer to be doing is to understand your biomechanics, understand your goals – Do you want to lose weight? Do you want to bulk up? Do you want to slim down? Do you just want to be healthy? – to understand what motivates you.”
“You want a personal trainer who, when times are tough, is going to support you and help you out. Sometimes you turn up and you’re tired, and you’re not as motivated as you should be. Sometimes you’re distracted.”
“Sometimes, you’ll actively work against the training program that you’ve said you’d work towards. You haven’t kept to your diet. You haven’t done the additional work that you said you were going to do outside of working with your trainer. You’ve done too much or eaten too much. When times call for it, it’s important that the leader calls that out and actually brings people back to what’s important, and gives them a good organisational ‘kick in the butt’.”
“We advise the minister of the day so that the government can pass legislation that is sensible and provides a better outcome for the community,” he says.
“I hope that there are lots of good ideas that come out of the parliament, and they progress the economic as well as the social part of the state. I’m looking forward to it. It should be a good term of government.”
Looking back at how he has progressed, Michael could never have imagined being in the role he’s in now.
Throughout his career, he has seen many people who impose restrictions on themselves on what they think they can do.
“They limit what they’re capable of doing,” he says. “My advice is to not be limited by your own beliefs. Expand your beliefs of yourself. Back yourself and expand what you can do.”
“I think it’s about always being open to opportunities; always developing yourself and continuing to learn, but also seizing opportunities when they arise as well as connecting with people.”
“You need to be able to work with other people, and your career will often take turns that you don’t necessarily predict but will usually survive and succeed in.”
Thanks to Michael – dubbed ‘Mr Fixit’ by mainstream media during the worst of the payroll crisis – Queensland Health has found itself well and truly out of the woods.
He has found himself in a groove and is enjoying his career. Would he have done anything differently?
“I don’t think I would have,” he observes.
“Having done a range of varied things has allowed me to see issues from different perspectives and understand where people may be coming from in relation to what they want to achieve and how they’re dealing with their day-to-day problems.”
“I’ve enjoyed my career and continue to enjoy it.”