GUEST BLOG: Ian Powell – Health New Zealand turns to Star Wars and the Ancient Sith; what would Yoda say?

From time to time, when representing salaried medical specialists over many years, I would come across some real toe curling (back in the day I used the descriptor ‘toe cringing’ but ‘curling’ is the correct term). Synonyms for ‘toe-curling’ include embarrassing, humiliating, painful, awkward, unfortunate, shameful, undignified, ignominious and unseemly.

These experiences were rare but memorable for the wrong reasons. Overwhelmingly people in management (health ministry and district health boards) spoke plain language in a practical way. But there were exceptions (disproportionately from policy ‘wonks’ and human resource managers).

These were largely well-intended people who lived in a bubble of likeminded souls isolated from the practical reality of what a health system does and what makes it both tick and work better. But when they got into full flight it was awful to witness.

On these occasions I could feel my toes struggling to get blood circulation. But these devotees in their full glory were impervious to their audiences discomfort.

Now the highest echelons of the most critical organisation in the Labour government’s restructured health system – Te Whatu Ora (Health New Zealand) – has created its own ‘cognitive bubble’ of likeminded souls.

Similarly, they are also isolated from the reality of the health workforce in communities and hospitals beneath them and the common sense of patients, their families and the wider public.

Here come the ‘wayfinders’

Te Whatu Ora has created four regional positions called ‘wayfinders’. The literal meaning of wayfinders are people who find either a physical route or a means to achieve something. It appears to be a trend in some organisations. There is even a wayfinder app.

The first report of the arrival of wayfinders in our health system was by Stuff (27 December 2022): The first Health NZ wayfinder appears. The other three positions have now been filled although one is interim.

One origin of wayfinders is early Polynesian navigation. Wayfinders successfully helped migrate Polynesians among and settle in more than 1,000 scattered islands in a triangle between New Zealand, Hawaii and Easter Island. They were also used by Inuit in the vast isolated domain of the Artic.

But there is another more relevant origin of Wayfinders – the Star Wars films. More specifically, the evil ‘Ancient Sith’ who were the sworn enemy of the noble Jedi of which Yoda was the most famous. According to Star Wars, so it must be true, the Sith was an ancient religious order of Force-wielders devoted to the dark side of the Force.

Wayfinders were created by the ancient Sith. Each wayfinder was entrusted to a Sith Lord to advance the interests of the ‘Dark Side’, the evil corrupter of everything. Ajunta Pall was the first Dark Lord of the Sith. He founded the first Sith Empire and expanded it onto other worlds.

The most iconic Sith Lord was the former Jedi Anakin Skywalker who became known as Lord Darth Vardar.

Wayfinders place in Health NZ’s structure

Wayfinders are not only part of Te Whatu Ora’s formal decision-making structure; they are very senior positions – in the third tier. They report directly to the National Director of Commissioning (national directors are second tier reporting directly to Chief Executive Margie Apa).

Each of the four regions set up by Te Whatu Ora, where each of the wayfinders are located, have regional directors. It would be logical therefore to have regional leadership meetings chaired by their regional directors.

However, the ‘cognitive leadership bubble’ has determined that this would make them too hospital-centric. Instead their wayfinders chair the meetings.

There are two big problems with this. First, hospitals deal with the more complex and urgent cases that can’t be dealt with by the rest of the health system. Consequently, for Te Whatu Ora, 24/7 acute hospitals are inevitably where the greatest risks to patients and to the health system occur. Things that go wrong are more likely to occur in hospitals than in community care.

Second, the wayfinders have very limited experience with these acute hospitals (with the exception to an extent of the interim appointment). Their experience is more in areas where things are less likely to go wrong.

This means Health New Zealand’s regional meetings are unable to sufficiently focus on the biggest risks the health system is confronted with. Balance appears not to be on the ‘cognitive bubble’s’ radar.

Now for a bit of data wrangling

Wayfinders are not the only creation of the new national bureaucracy’s ‘cognitive bubble’. Also in the third tier is a position called ‘National Implementation Lead’. This position has three teams immediately below it.

The first two teams are finance and contracts coordination. The third, of equal status, is ‘Story Telling’. Sitting below this team are ‘story collectors’. Presumably this was used to be called communications.

Next to these ‘story collectors’ are ‘Data Wranglers’. Technically there is at least some legitimacy to this title. ‘Data wrangling’ is the process of removing errors and combining complex data sets to make them more accessible and easier to analyse.

However, the word ‘wrangling’ has an unhelpful meaning of its very own – to engage in argument or controversy or to obtain by persistent arguing or manoeuvring. It can also mean herding livestock, especially horses, on the range!

The use of this unfamiliar and ambiguous term will be linked in many minds with the fictional implications of ‘wayfinders’ and ‘story tellers’. Data analysts would have done perfectly well and is a familiar term in the health system; but this term was outside the bubble.

Advice from Alice: “If I had a world of my own, everything would be nonsense”

What this whole nonsense highlights is the highest level of a leadership structure living in a ‘cognitive bubble’ isolated from both those in its lower levels working in the real world (service related managers and administrators as well has health professionals) and the rest of society.

In the specific context of the deteriorating crisis the health system has been forced into by longstanding bipartisan political leadership neglect, we have a restructuring that makes little sense to most of those working in it. Health professionals are confronted daily by exhausting unabated pressures.

Non-clinical staff (including managers and administrators) previously employed by district health boards now find themselves working in an unsettling more vertical and directionless environment that overwhelmingly they never wanted or were consulted over. Much can also be said of the former health ministry staff transferred across to Te Whatu Ora. For both groups it is demoralising.

Throw frustrated and overworked health professionals into the mix and the health system has imposed on it a recipe for organisational dysfunction at a time of pre-existing crisis. Bubble logic such as wayfinders and story tellers only makes it worse.

Even if the Polynesian or Inuit origins of the former are considered, it makes no sense. These wayfarers worked in sparsely populated large ocean or land expanses.

There is no similarity with these historic migrations and New Zealand’s health system which by its very nature is well integrated and based in terms of  geography and high density populations in a small country.

Further, it demonstrates a poor understanding of how universal health systems work. They are based on teamwork and depend on the prevalence of a culture based on engagement. Health systems don’t depend on a few designated individual positions masquerading as ‘magic bullets.

Throw Star Wars into the mix and the bubble begins to look like an ideal script for Rowan Atkinson to have fun with. For some years, when a health professional takes up a senior management or chief executive position there are the odd comments, usually jokingly and sometimes unfairly, about going over to the ‘Dark Side’.

Now we have exhausted and demoralised workforces being subjected to the unneeded pain of toe curling. Te Whatu Ora’s leadership needs to understand (quickly) that the buzz of their bubble does not go beyond the bubble.

The best description of this ‘cognitive bubble’ thinking can be found in Lewis Carroll’s Alice in Wonderland. With extraordinary foresight Alice opined that “If I had a world of my own, everything would be nonsense.”

Someone needs to quickly advise the leadership of Te Whatu Ora that Alice in Wonderland is not non-fiction. Perhaps we should blame George Lucas the Star Warscreator for this toe curling bubble. The legendary backwards speaking Jedi, Yoda, would probably say “F### the what!!!”

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion