Digital healthcare platform founders
As noises are made about postponing Santé Québec’s digital platform, the visits of a onetime SAAQClic official to hospitals has become controversial.
Is it that these sprawling computer systems run up against technical limitations? Or is it that dysfunctional digital structures reflect flawed human and social relationships? Are the broken networks us?
bob 11:02 on 2026-04-11 Permalink
1. Yes.
2. Yes.
3. And how!
R T 12:20 on 2026-04-11 Permalink
I (somehow, as it’s not my normal job) worked on the post-mortem for a government IT project that is like SAAQclic (but not SAAQclic itself), and in addition to the answer to all three questions being yes, government IT projects often have a “Christmas tree” nature. Functionaries realize it’s their one chance to include x, so they propose that it includes x; everyone has their own x, and it’s no one’s job to say no, so you end up with a proposal that’s extremely prescriptive about what it has to be able do. Layer on top of that the fact that government departments are, to put it mildly, generally averse to changing or updating their processes, so they demand x be done in a certain way, and operate in an extremely narrow regulatory environment, so x may be legally required to be done in certain way. (These certain ways are often often, to put it charitably, outdated and inefficient or, less charitably, illogical or downright stupid.)
Contracts that demand thousands of things be included and be done in a certain way, things and ways that may not even be feasible, somehow tend to go off the rails.
(Phoenix is a good example of this. “You must include all the Government of Canada existing pay rules and processes.” It turns out many of these processes are based on business practices that were abandoned in the private sector years ago and moreover vary by department; two departments may have exactly opposite requirements. Then, within the department, there are rules that differ for each work group, some of which may be union contract requirements and some of which may be mistakenly believed to be union contract requirements. Of course, there is no central repository of all these processes and requirements, and the purpose and origin of these rules may not be written down anywhere at all!)
Kate 13:10 on 2026-04-11 Permalink
Mission creep. It afflicts big projects, especially government ones. I wrote about the phenomenon in a different context awhile back.
Nicholas 13:22 on 2026-04-11 Permalink
There’s a lot of fiasco going on, but I’m not immediately opposed to high ups getting their hands dirty to see how things actually work in the field. Often things don’t filter up to the top (see, e.g., SAAQClic), and having worked at the bottom I’ve seen pronouncements come from the capital that make zero sense on the ground, as if these people have never spent any time seeing how their department actually works. When a visit in the field is arranged in advance you’ll have minders that ensure you only talk to the right people, and no one gives an opinion outside the company line. You are liable to get different biases from an unannounced trip, but they can really be useful.
There’s a famous photo from 1989 of Boris Yeltsin in a grocery store in Houston. He was on a tour of the US and decided to go on a whim to check out how the capitalists did groceries. He was incredibly surprised to see the massive selection, and knew it couldn’t be faked because they only reached out to the store 15 minutes before arrival. He spoke to customers about their salaries compared to food prices, and during his next flight an aide said “the last vestige of Bolshevism collapsed inside” him, with him saying if the Soviet people knew how different life was there would be a revolt. Sometimes it’s not just the public who’s unaware of things, but leaders themselves, and going around the official channels can sometimes help
Kevin 10:48 on 2026-04-13 Permalink
Nicholas
Life imitating Art — specifically Moscow on the Hudson https://www.youtube.com/watch?v=VHIcmoY3_lE