Who the DoDHA picks to next run the ADHA will be defining of the will, intent and ability of the department to transform our healthcare system.
Listicles are fun right?
I began writing this one in a now time honoured way by asking Claude to help.
The prompt:
Morning Claude. Can you give me your best shot at the top 10 candidates to replace Amanda Cattermole as the CEO of the Australian Digital Health Agency. You can select from internal agency candidates, local candidates and international candidates. Do not use anything I’ve ever written or said, do it yourself. In order of best candidate to least best 1-10, with a very short explanation for the pick.
Sadly, Claude came up with a list that was a mix of a few good candidates – Enrico Coiera, Johanna Westbrook, Zoe Wainer – and a few that didn’t bear much resemblance to the biographies it attached to them.
There were also a few on the list who shouldn’t have been on any serious list of candidates…hmmm, and look at us all worried that it’s so smart it will go sentient soon.
Claude summarised its list attempt with:
“The honest meta-point here is that the ADHA CEO job has historically attracted public service generalists rather than people with genuine digital health depth, which is why the agency punches below its weight”.
An “honest meta-point”? What’s a “meta-poiint”?
Honest or not, Claude was only half right again: “the agency punches below its weight.” Though that’s so much of an understatement it’s almost inaccurate as well.
Let’s keep to the listicle vibe but attempt something a bit more logical and factual.
Firstly it’s important to point out the stakes here.
If the secretary of the Department of Health, Disability and Ageing Blair Comley doesn’t take this appointment seriously, and do a lot more than what we often see in a public service agency appointment – politics, shifting deckchairs, reward for work in another department, etc – then he would be signalling to history that he either doesn’t really care about the proper transformation of our healthcare system, and is along for the ride (like some before him seemed to be), or he’s not competent to be the head of the department.
Comley is more than competent.
Why the appointment is so important
More than ever in history, technology is offering us up an opportunity for transformation.
But like all sector transformations, the technology isn’t the solution, it’s the tool. So, the workman wielding the tool is everything: it’s about people and change first, but you have to understand the technology to manage that.
What Mr Comley needs (wants?) isn’t easy to come by these days because healthcare doesn’t have much of the following talent, certainly in Australia. The role needs someone who:
- is an accomplished manager (leader) of people who can move between a complex milieu of stakeholders, many of whom are scared and threatened for their future currently, and politicians of all ilk;
- intimately understands and follows the technology opportunity, in particular web-based connectivity and AI;
- is from healthcare and understands all the policy issues, the challenges of our federated healthcare system management structure, and every good and bad aspect of how countries overseas are managing this transformation;
- will stick around for at least five years to get this transformation going;
- nice to have – has coalface clinical experience of the system (ie, is or has been a clinician).
- Is happy to be paid about $600,000 or less … (the package of the previous CEO).
So, easy then.
A couple of starting points.
There are some truly good people working at the Agency currently, but none of them have this profile and the agency is divided internally in all sorts of ways. So, any internal candidate, good or not, would struggle with the existing politics.
In addition, while the agency has done some good work on planning and setting objectives in the last few years, its overall performance in terms of delivery is very poor, so any internal candidate would have this hill to climb as well.
Bringing in someone from another government department, even your most talented person, will very likely not work either.
It took the last CEO a couple of years to get up to speed, which is the nature of the complexity of healthcare (we are including aged care too). And even though the past CEO did get up to speed on the issues, the fact that she came from outside healthcare entirely was a massive disadvantage all the way through the tenure, from knowledge to gut to contacts to a coalface understanding of the real issues faced by those delivering healthcare.
Okay, where to start?
Here’s my listicle of candidates. But to be clear, I have a very superficial view of this problem as I’m a rank outsider in many of professions from which we must choose.
My list is only to demonstrate the idea of why we need someone competent for the job, different from anything we’ve done in the past, and keeping in mind that this appointment is probably the most important single appointment the DoDHA will make for the future of our healthcare system at this point in time.
My list does not have a best-to-worst order to it. Each person is good for different reasons. So ignore the order I’ve put them in I’m just trying to keep that internet listicle vibe to the article. I’m also only going to suggest five names … enough to give everyone an idea of the sort of person we really do need in this job.
Daniel McCabe
Mr McCabe is the past head of Medicare and Digital Health in the Department of Health, Disability and Ageing, now seconded to someone deep in the bowels of a different department – the Health Technology Assessment Reform group.
He’s trying to nut out a pharmaceutical pricing deal for the next five years or so amid huge international disruption to pricing, and a local pharma sector that has been told by their overseas bosses to pull up stumps and move out because Australia is too small to worry about.
This is a very important negotiation. I’m going to argue it’s not as important as sorting out the digital infrastructure problems of our healthcare system.
Mr McCabe is a public servant with the most intimate knowledge of the issues, is a great communicator, respected, sharp at managing the politics, and knows what needs to be done.
Cons? Public servants don’t really ever have a great deal of good leadership and change experience. The Agency is like a company, not a department and that is a very different challenge, especially given how deeply down some bad rabbit-holes it finds itself.
Another possible problem: he lacks coalface system experience so he’d have to get some of those people close to him and listen. But he’s a great listener.
Steve Posnak
Mr Posnak is the current and long-term principal deputy national coordinator for health IT in the US. He is possibly the most talented and professional healthcare technology policy and regulatory expert in the world, having been with this US department for 21 years, where he has been a critical part of the largest system digital transformation in the world (it’s ongoing).
That includes developing, establishing, deploying and overseeing the constant ongoing adaptive change of the US system under two giant transformative legislative and policy changes to that country: the HITECH Act of 2009 and the 21st Century Cures Act of 2021.
He has the highest level of communication skills – does anyone remember Simon the Likeable from Chaos in Maxwell Smart – huge intellectual capacity (though humble and understated). He’s the Daniel McCabe of the US.
Cons? These aren’t so much cons as he’d be hard to get: he loves his job, he’s been there a long time, he’d probably not want to leave because AI has hit and there’s so much new to do in the US to up the pace of interoperability, connectivity and system efficiency, and … he has young school-age children.
But in recruitment you never know until you ask, right? He’s someone you can model all your candidates against.
Professor Tony Lawler
Anyone reading my op-ed on Thursday might be amused by this choice as I had a fairly big go at the TGA, which Professor Lawler heads up. He’s also Dan McCabe’s boss, coincidentally (perhaps we could draft them both – a sort of A Team).
I’m going to admit I don’t actually know a lot about Professor Lawler but it is the sort of CV that ticks a lot of boxes: coalface experience of the system as a clinician, leadership experience, understanding of the issues, good people person, thinker, demonstrated commitment and intent to making things better, and comes from Tasmania (what? it’s a great state).
Cons? In public service terms he’d be taking a demotion and the TGA certainly needs his talent – but we need to look and think laterally here … the TGA can be managed without him. We’d have to up the pay probably, and convince him of how important the government now sees this role … hmmmm.
Professor Zoe Wainer
This is a similar deal to Professor Lawler — a very talented candidate in an important job – deputy director-general of the Australian Centre for Disease Control – but nowhere near as important as this one, sorry.
She has great leadership credentials, lots of coalface experience, both as a clinician and a healthcare manager, in both the public and the private sector. She is well connected, and a consummate communicator.
Cons? Same as Professor Lawler … reasonably new in a big job already. Again, we need someone of this calibre, it’s just about how much the government understands how important this role actually is
Tim Ferris
Mr Ferris is the former national director of transformation for NHS England. He is a physician (trained in internal medicine) who ran NHS England’s transformation directorate at national scale under Amanda Pritchard (CEO, NHS), overseeing elective recovery, digital and data programs across the entire English health system.
He’s since returned to the US, which might make him recruitable. He bridges clinician, operator, national health policy, leadership, and digital health knowledge in a way few people do. No existing Australian profile means no baggage, which in ADHA terms is a genuine asset.
Cons? The last time we did this was Tim Kelsey, who came from the UK and managed the whole opt out My Health Record thing.
Mr Kelsey was a talented and charismatic leader who in the end took us down a big rabbit hole with opt out on the My Health Record, a version of which he’d done in the UK and he was convinced about.
Or maybe he wasn’t and he was just flowing with the political wind which was we can’t retreat from the My Health Record sunk cost. Who knows? But it didn’t work.
Related
Apology to a lot of people
If you’re not on the above list and you should be, I apologise. There are others who look similar to the above list, especially 3-5.
I’m not trying to attract an executive search fee here (although if DODHA picks any of the above I’m sending an invoice). I’m trying to make a point to Blair Comley and Mark Butler.
Do not treat the role of CEO of the AHDA as we have in the past. Do not treat the ADHA as you have in the past.
With AI smashing into the health system everywhere now, and the rate of change for all stakeholders suddenly bewildering, you will not have made a more important appointment in your lives.