The health service lottery

A correspondent writes:

‘In the UK we now have National Health Service league tables. They tell you in which county you are most likely to die under the surgeon’s knife and so on. As a result, surgeons are now avoiding risky operations and only performing the easy ones – to keep their performance figures looking good. It is also inevitable that good surgeons working in difficult conditions are being marked down, while less competent surgeons who are lucky enough to be working in easier conditions are given gold stars.’

We also heard yet again that Health Authorities are massaging their waiting list times. The Prime Minister, like the Health Secretary before him, said these people will found out and blamed. It is not their fault.

These phenomena are normal consequences of arbitrary targets. The Health Service, like all of our public services would be much better off if people were encouraged to work with capability measures – measures taken over time that showed their achievement of purpose. This would foster their ingenuity in improving the system, rather than having it focussed on being seen to make the arbitrary targets and, moreover, making the system worse.

And more on the Health Service.

It has been reported that more than £700 million of taxpayers’ money allocated to the National Health Service was not spent last year. Liam Fox, the Conservative Shadow Health Secretary, said that the large under spend revealed that the centralising tendencies of the Government meant that managers on the front line were afraid to make decisions. ‘There is complete initiative paralysis,’ he said. ‘Mr Milburn (the Health Secretary) seems to think that he can run an organisation with more than one million employees from behind a desk in Whitehall.’

Thanks to the same correspondent for this:

‘I know no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise that control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion.’ Thomas Jefferson

People in our public services need help, not coercion, bludgeoning and blame. I really think Ministers should get out of management.


Do you have any difficult people?

Over the last year a number of systems thinkers who are members of the Vanguard Network have told me that they have been labelled as ‘difficult’ or ‘in need of inter-personal skills training’. It seems they have one thing in common, they question what is being done in their organisations / what is said in meetings and so on. Despite all the rhetoric about people being involved, innovation being fostered etc, our organisations stifle ingenuity and/or ensure peoples’ ingenuity is focussed on the wrong things.

If you hear of someone being labelled as ‘difficult’ or ‘in need of inter-personal skills training’, go give them a good listening to – they may have something important to tell you.


More trouble with ISO 9000

ISO 9000 community urged to ‘police itself’ ISO 9000 certification bodies and the accreditation bodies that approve them as competent need to do a better job of policing their community to weed out malpractice and dishonest operators, ISO Secretary-General, Dr. Lawrence D. Eicher, has declared.

The ISO Secretary-General said that the conformity assessment community was facing a serious challenge caused by a certain number of certification bodies which acted without integrity.

Although ISO itself does not audit companies and does not issue ISO 9000 certificates nor control the certification bodies that do so independently of ISO, these bodies base their business on ISO standards and guides. ‘Therefore, when certification bodies act without integrity, many people believe that it is ISO’s fault,’ Dr. Eicher said.

‘We regularly receive complaints about certificates being awarded undeservedly to companies who have not been properly audited, or about certification bodies who offer to write the quality manual for the company and then sell them a certificate, or about others who claim to have been approved by ISO. No one at ISO has ever approved such certification bodies.’

Dr. Eicher said that ISO was concerned about such practices and that all conformity assessment professionals needed to be concerned too if they wanted to avoid being seen as ‘charlatans’, concluding: ‘You need to police yourselves.’

It demonstrates a fundamental weakness in the ISO 9000 philosophy. Policing the policemen will not solve the route of the problem. These problems are a natural consequence of market-place coercion. The only way to stop them is to stop ISO 9000. It is of no value to organisations anyway (newsletters passim), so that should be an easy decision. But we couldn’t expect those who make a living from it to take such a view, could we?


From type 1 to type 2

At a recent meeting of the Vanguard consultants we were discussing the growth of imaging. Managers buy imaging technology to put paper on to IT systems in order to route, control and inspect work.

Many of the current steps in the work are examples of type 1 waste – things you can remove and be better off immediately. By implementing imaging technology, managers turn type 1 waste in to type 2 – you cannot get rid of it without re-designing the process – that means taking the imaging technology out.

Of course managers point to the cost saving of imaging technology. When they do so they compare the costs with having people do the first steps of the work instead. They should instead look at end-to-end costs. Often (and in very case I know) they will discover that imaging technology leads to costs increasing. Of course if they find this out they’ll be inclined to keep quiet about it. and so you find organisations stuck with waste they could so easily remove.