- Freedom from command and control – the show
- You please some and upset others
- Seddon is a ‘lone voice’?
- Absenteeism is a symptom
- Minister defends targets
- The consequences of health policies
- Ambulance service gets the wrong solution
- Less “excellence” decreed in the public sector
Freedom from command and control – the show
I have had a very interesting month travelling around with a cameraman filming people talking about their work. En route I was delighted by many things, and I want to share just one. In Dundee people from health and social services have worked together to redesign adult care assessment. Of course their results were terrific, but the thing I liked the most about it was the way they did it. The interventionists knew that to tell people what was wrong and explain another way would just create resistance; so they designed activities that would teach this to the people for themselves. When
you do it you get it. A well designed and expeditious intervention.
By the way, the show will be just that – a show. It will feature people who are doing it, talking about what its like. They exemplify freedom. Don’t miss it.
Following my comments on Investors in People (IiP) in the last newsletter, a reader writes:
“re: IiP, I have two nicknames for it:
“Investors in Paper” and “Isn’t it Pointless”.
My piece upset an IiP expert, I am sad to say. I was accused of not understanding the latest standard, so I have asked for a copy of the up-to-date guidance etc. Watch this space.
As readers will know I published my criticisms of the Call Centre Association’s ‘best practice’ standard last month. Apparently the CCA described me as a ‘lone voice’, not representative of the ‘industry’. And so it should be, I would not want to represent something I don’t even think of as an ‘industry’.
But I am not alone; every Vanguard client with a call centre (not an ‘industry’ but a feature within many systems) knows not to follow the guidance provided by this standard. More importantly, these people know why it is bad guidance.
I might be a small voice if not a lone one, but I feel obliged to shout to people that if you use this standard you will only damage performance; service will be poor and at high cost. If you haven’t read my criticisms yet go to: https://www.01handshake01.com/v1_lib.php?current=933
Absenteeism is at an all time high in the public sector. It is of no surprise, there are so many things going on that cause de-moralisation (targets, bureaucratic specifications to comply with – all things that distract from purpose). In the private sector, managers seem to have become inured to high rates of absenteeism and turnover in call centres. Yet the causes are easy to remedy.
Managing absenteeism gets you more of it. Royal Mail management now award prizes for attendance; if you come to work without taking time off you get put into a draw to win a car. Managers would be better off removing the causes of de-moralisation; it would cost them less, it would make the work more interesting and it would mean people would want to come to work without bribes.
Removing the causes of demoralisation will not be achieved by communications, workshops or other daft ‘people motivation’ stuff. It can only be achieved by redesigning the system, that’s the cause.
Patricia Hewitt, the new minister for health was told by Jennie Blackwell, a delegate at the British Medical Association (BMA) conference, that targets make her hospital a war zone. The minister trotted out the government’s usual defence: There have been too many targets, so fewer will be better (where is the logic in that?) and the targets used to date have led to improvement. That is just not so. Targets, by their nature, always damage performance. If you need to read the argument more fully go to https://www.01handshake01.com/v1_lib.php?key=kelly&id=923
Mrs Hewitt is also on record as saying:
“But no organisation can cope with this top down, command and control approach for ever. We have to move from reforms that depend upon tough performance management, to embedded reforms that create a powerful, in-built dynamic for continuous improvement.’
I wonder if she is learning?
Dr Paul Miller, chairman of the BMA’s consultants’ committee says government policies could end up harming patients’ interests instead of improving services. His argument is that providing new specialised treatment centres will destabilise the NHS.
Ministers seek economies of scale; they want to get the costs down. But in truth they are more likely to put the costs up. Hospitals that used to provide the service will be forced to reduce their capacity (cutting beds and staff). Patients that don’t fit the specification, some because their case is too complex, could find no provision left in the NHS. If there is no provision, they won’t appear on a waiting list. If there is a provision patients could be forced to travel anywhere in the country.
These are some of the knowable costs. Consider the long-term cost of the impact on surgeon’s training and hospital research.
The minister’s policy tampers with the system. It will become apparent if NHS managers took measures of end-to-end time from first presenting to diagnosis and treatment (as time-series data), and time-series data about outcome. The increases in variation that will thus be exposed will be indicative of the extra costs of the policy. By designing against demand we would learn to provide better services at lower costs. If only the minister knew.
We have just seen the publication of a new plan for ambulance services. I know it won’t work. Of course it has plausible and maybe necessary features, like sending out more limited resources, as they clearly have learned something about demand (few calls require two experts in a fully-equipped ambulance). But any design created in a management factory will be subject to fundamental flaws. Demand will vary by geography, population and so on, any specification or rule book will render the system to be less able to absorb that variety. It maintains the measurement of arrival time, mandating how this will be measured to remove inconsistencies is merely doing the wrong thing righter. We need to measure achievement of purpose. The intent is good and needed; we should make sure the service actually solves peoples’ problems by the most efficient means. But the intervention (telling them) will ensure resistance, some of it justifiable.
The right answer is to liberate method amongst the ambulance personnel. That would first require the right measures. And that would first require that the minister learn something.
And then there would be fewer jobs in the management factory.
The chancellor, Gordon Brown is reported to have ordered the audit commission to make sure that no more than 12 Councils are rated “excellent” this year. Currently 41 councils have “excellent” status.
The reader who alerted me says: “I’m sure they know what they are doing even if we don’t.”
I am sure they don’t.
My bet is the chancellor is getting fed up with waiting for ‘improvement’ to fall through to the bottom line. He needs the money, so I guess he thinks they need a bit of a kick up the…
If only he knew.