Why Germany failed to combat COVID-19: inefficient bureaucracy and no technology
Be aware contains strong language because of my personal frustration and inability to improve the state of affairs in these domains!
For a more constructive blog post, see here what BPMN process modeling can do to improve the process!
I wanted to save this story for my Digital Solution Anti-Pattern series. However, Stefan Tilkov has published a (German) article about his opinion and observations about Germany's failed battle against COVID. I wanted to share some observations which I have made, which complement Stefan's observations: I totally agree with Stefan that IT is very much undervalued and whoever only approved 4 out of 60+ requested IT positions in the RKI should be fired (Stefan only wants to give them lower-level positions but I disagree).
However, the fighting of the pandemic is not only hindered by missing software and computer systems. It is a prime example of failed digitization, which not only uses software but also optimizes business processes and focuses on the customer. One can argue that state-led departments have no "customers" but I disagree. We pay taxes to finance core services of our society and we can demand that this money is spent to manage and advance society efficiently. While I like to rant about the fact that no (visible nor effective) preparation was done during the summer months with regards to test capacities and protection measures, I want to focus on the digitization aspect of the problem in this blog post. We will look at two examples out of my personal environment and it quickly becomes obvious to external observers what core organizational failures are.
Example 1: Nanny's son is COVID-positive
Let's go to a very small and easy example first: The daughter of a friend is sent to a Nanny (pre-kindergarden). The nanny's son was tested positively on COVID. This led to a classification of the nanny to K1 (first level contact) and a quarantine. However, she was never tested, and the quarantine ended after 10 days. No further tests were made and she was allowed to babysit a group of 5 small children.
The quarantine rules are totally stupid. There is a person who can super-spread the virus but yet no means to test and go a safe route have been taken. This is not an IT problem but a problem with quarantine and test rules and capacities. Change the rules. Just turn on your brain. It should not be that difficult.
Example 2: Quarantine of a Kindergarden
Other kindergarden, total desaster. One external sport teacher was tested positively, who supervised all kindergarden groups on two days in a week before positively tested.
- All children were classified as K1 (first level contact) and quarantined (okay)
- No parents were qurantined but instead had to work while no kindergarden was available (closed to quarantine) and no childcare was allowed at home (due to the kid being in quarantine). (BAD)*
- Quarantine started on Friday evening (via email forwarded by the kindergarden), test was only scheduled on Tuesday (parents should work in that timespan!) (BAD)
- Quarantine rules state that the child should eat & sleep alone and play alone in its room (remember: kindergarden, 1-5yo kids) (UNREALISTIC)
- Test invitation listed Tuesday as the weekday but Friday's date (BAD)
- Test was scheduled for ALL children (100-150) on the SAME day at the SAME time (?!?!?!)
- Test was to be conducted at test center approximately 45 minutes from home (ok... but we live in a large city)
- Test was scheduled at 7pm (1-5yo kids) (far too late)
- Child (remember 1-5yo) shoud wear a mask in the car (won't last for two seconds)... (UNREALISTIC)
- Only one parent allowed in that car (same household, I suppose the risk of spreading is not decreased by this) (why?)
- Adult should wear a mask while driving while explicitely stating that German laws demand that you are identifiable while driving (UNREALISTIC)
- Test is to be conducted through the back window of the children's seat. Adult is not allowed to leave the car (UNREALISTIC)
- Test results will only be conveyed if tests are positive (information theory anyone?)
- Quarantine letter (written form) arrives at Wednesday but is specified to quarantine the parents but not the child. Calling authorities revealed that the letter was written to be "misunderstandable" but that indeed the child was quarantined.
- No test result was available after 2, 3, and 6 days (of course parents called, so more work for officials)
- 7th day after test: quarantine automatically completes. Official answer for test result: The test results of this batch are missing (BAAAAAAD).
- Kids goes to kindergarden with no test result
- A day after implicit quarantine completion, a written, corrected letter arrives that states that the kid was to be quarantined till yesterday.
- After ~3 weeks a letter arrives that the quarantine had been indeed completed.
Of course, these things lead to many telephone calls by the parents thereby increasing the workload thereby hinder other tasks. By making so many mistakes and communication errors, it is easy to overload a department, thereby rendering it ineffective and not operable.
There are so many things to discuss on the organizational and IT level that I do not know where to start first. Remember, officials (with this I mean the ones in charge for the organization and not those who are burnt at the frontline) had the whole summer to prepare for the second wave.
- Wrong forms and no reviews,
- Letters at wrong times,
- Wrong rules for organizing tests,
- Insufficient test capacity,
- Again at least impractical to nonsensical quarantine rules,
- No automated processing and forwarding of test results,
- No good communication strategy.
I have designed an improved business process in under an hour for a seminar that I teach at the University of Oldenburg:
- Business Rule Change: Schedule separate test times for each child in order to better allocate resources and avoid waiting times.
- Business Rule Change: Forbid late times for small children (and old people).
- Business Rule Change: Also quarantine parents of K1 kids (first level contact).
- Data Management Change: Give each test an ID that the parents and everyone else involved knows
- Process Structure Change: Return the test result every time (no matter the outcome) to the parents by letting them query a Web application with the test ID. (No, not via a COVID tracking mobile app because small kids hopefully do not have a mobile).
- Process Structure Change: If test is positive, notify parents immediately
- Software Support: Let labs enter the test results (by ID) into the Web application. The data can also be used by authorities to avoid any paper/phone/fax transmission.
- Improved version: Automatically forward test data via integration to the central Web app.
- Short-term solution: To not further increase workload of labs, get students to enter the data from paper into the Web app.
- Intermediate solution: Lab systems probably have some file export. Upload those files and parse them.
- Software Support: Rework the letter templates
- Software Support: Automatically sent (and print!) letters based on events and timers.
Obviously, I don't know the internals of these organizational structures and especially I have no knowledge about the backend processes involving test centers and test labs. But if these are hindering this process it's time to also fix them. Otherwise, there might be small details left to fill out. If there was a will to change and improve, there had been the possibility to optimize the process, and write small software applications where required that improve reliability and automate many things (thereby reducing workload) over the summer. I would estimate that I could write the software within 1-2 weeks and if there is no system integration to the labs evaluating the tests than some students could have entered the data for getting it all started until an integrated solution is in place. Plus experiences from the first wave in Spring and one week for business process workshops plus one week for software development and we'd been far better off than today.
These are very, very basic failures in a business process. If authorities were companies, they would be out of business since ages. I join Stefan's opinion that we should and must improve that and it would greatly benefict our society and democracy. I tried to funnel this experience and my improvements suggestions to officials but to no avail.
These failures are not only directing hurting the efforts to combat the pandemic. They also undermine trust in the rules, the administration, and politicians and thereby indirectly hinder the combat of the pandemic even more. This effect will also stay after the pandemic and is therefore troublesome. I would like to see a quick reaction and improvement to the problems and would be honored to participate in that! But there are even no (public) efforts to fix basic problems. Yesterday, more than 3000 positive test results were not transmitted to the RKI. Probably there was no paper left in the fax machine...
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Dr.-Ing. Daniel Lübke is a Digital Solution Architect, who enjoys realizing high-quality business processes in software. He has over 10 years experience in architecture of distributed systems (from SOA to Microservices, BPM and workflows). Daniel likes to find better than "state of the art" solutions by combining methods from Software Engineering and BPM, in addition to researching promising, uncommon solutions. He is book author, editor, and speaker at conferences, and has published many articles in different magazines and journals.