Flu Jab Warnings

Kill the messenger? Agamedes notes a variation: attack the person who failed to send the messenger.

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Flu jabs, sick kids, a bad combination. No-one likes to read about sick kids. When flu vaccines are alleged to make kids sick, plenty of people get upset.

"We need to know when the Government found out and when it responded, and whether the information that was needed was there in the first place," says shadow health minister Roger Cook. (From "Calls to examine 'late' flu jab alert", The West, 29 Apr 2010.)

"The Minister needs to tell Parliament why the system seemed to fail mums and dads," he continues. Note the use of "mums and dads" rather than "parents"? So much more emotional, don't you think? So much more tugging at the heart strings. No mention, though, of failing the children... after all, they're not old enough to vote.

"We may need to have a formal enquiry..."

Cook is not alone in this view. As the flu jab issues were surfacing, there were general calls to find out what had gone wrong. Generally tied to demands that someone needed to be punished. For failing the mums and dads.

Is this "disaster recovery"?

Something has gone wrong. There is a disaster happening or, possibly, about to happen. But how do you know?

Several years ago I was in charge of a Disaster Recovery Planning project. If a "disaster" happened, the disaster recovery plans would be pulled out, and followed. One small problem:

We were planning for recovery of contracted services. If there were a disaster, contacted services would be thrown into turmoil. Costs would skyrocket. Key performance indicators (KPIs) would not be met -- we would all be busy recovering from the disaster. KPIs not met would result, under contract terms, in payment being reduced.

If, for example, an office were flooded... contract service would stop until the floodwaters receded. Then there would be a period of below-contract KPIs, while equipment was replaced. (That's a deliberate example. An office was, in fact, flooded. All systems were recovered very quickly; all the disaster recovery manuals remained closed and on the shelves.)

So, if there were a disaster, service delivery staff need to have it confirmed, so that KPIs can be adjusted. Service delivery staff want an early declaration of disaster. People paying for the services may want a delayed declaration of a disaster so they can pay less, due to missed KPIs.

For my project I asked, who would declare that this series of problems was, in fact, a disaster? I never did get an answer...

When dodgy flu jabs are (possibly) causing kids to get sick -- who will declare that this is a disaster?

Doctors? Health department? Nurses? Parents? Politicians? We need to be more specific: Who will declare a flu jab disaster: Which doctor? Which official within the health department? Which particular parent? Which politician? I would guess... that no particular person has been given responsibility -- or authority -- to declare a flu jab disaster.

If you don't have responsibility -- who do you tell? If you don't have authority -- what do you do? Remember: a false call and it's your job on the line, your reputation which will be ruined, your career which will be forever dogged by that one bad decision.

So, are we surprised that there is no-one to send the messenger?

Perhaps it's a process problem?

Australian Nursing Federation State secretary Mark Olson "wanted an inquiry into why authorities were slow to react". Yep, another call for an inquiry. We all want to examine past failures and allocate blame.

What's the point?

Surely what we want to do, is to make sure that it doesn't happen again!

There are a whole lot of management buzzwords, catch-phrases and motherhood statements about "quality processes". It is worth remembering: If there is a problem, fix the process... processes cause problems, not people.

Fix the process.

We had a problem, possibly a disaster. The process failed, because flu jabs continued -- apparently -- despite indications that they were causing problems. So improve the process.

Let the past be a warning: we now know that flu jabs may be less than perfect, we now know that warning signs may be missed, or warnings ignored. Now design a process that will work...

How will the process work?

It's all very well to say, we need a new process. An essential part of process development is, to set the process requirements. Consider each of these:

• Who will be responsible for identifying adverse reactions?
  
• Adverse reactions to what? Just children's flu jabs? All children's injections? Adult injections? The list is endless... Identify the essential items to be watched -- for this process development project.
  
• Do we want this project team to list some of the other contenders for a similar disaster identification process?
  
• Who will be responsible for gathering and analysing the data which may indicate an impending disaster?
  
• Who will be responsible for declaring, publicly, yes, this is a disaster?
  
• Who will need to be informed? Doctors? Parents? Nurses? Politicians? Parents? Someone else? Everyone else?
  
• Who will be responsible for developing this disaster-identification process?
  

That's a bare beginning. Now we can get serious:

• Appoint a project manager, identify team members. But that's not enough.
  
• Who must be consulted? Who must be informed? Who must ensure -- or agree -- that the final process is actually effective? This is standard "project management". Processes don't just appear, they must be designed. And that is a "project".
  
• Now... the project team can start its work. Including:
  
• Define what data will be collected. Number of injections? Number of adverse reactions, grouped by type?
  
• Decide, at what point is there a potential disaster. One adverse reaction? One percent of injections give an adverse reaction? Only adverse reactions which result in hospitalisation? Children who get sick within a week of an injection? a day? a month? ... Is there an absolute measure to indicate a problem? Probably not, so...
  
• Define the response to be taken at various levels of risk. Email to doctors at the very first sign of possible problems? Public announcements when suspicions are raised? Absolute ban on injections when... well, when?
  
• Name the person (or position) who will have the information, who will have responsibility to make the decision, who will have authority to take the action.
  

That's just off the top of my head. A good process is not simple to design. It is simply essential.

Don't waste time allocating blame. Shoot the messenger and you will never see another messenger. Develop an effective process, now. Learn from the past. Improve the quality of response, for the future.

Improve the process and you will gain benefits, well into the future.

Independent thinking & independent analysis of your problems by Agamedes Consulting. Support for your thought: email nick leth at gmail dot com