The Quality Renaissance

I am often asked how to get top management interested in systems thinking. The simple answer is you have to get them curious; you can’t ‘sell’ it to them. The reason is systems thinking is just that – a thinking thing – and if you get people curious they start exploring the ideas for themselves. It is important that they should, for they have to decide for themselves that ‘this means me too’. To ‘get it’ you have to unlearn as well as learn.

Many get started having attended an event. One event that may appeal is ‘The Quality Renaissance’, a presentation I shall be making for the Chartered Quality Institute (June 29th, London). It will feature practical examples from a variety of sectors. The audience will see that systems thinking works – it is more economically beneficial, it is better for customers and it is profoundly better for morale.

I shall also give examples where managers have backed off making the change. One such is mentioned in the blurb the CQI has published to interest people in the event. It is the story of a group of engineers who have refused to go back to the old ways despite successive managers trying to get them to back ‘in control’. The engineers’ results put them head and shoulders above others. Deming used to say: ‘Doesn’t anyone care about profit?’ I shall be exploring why some managers appear not to.

Kaizen Blitz

Another event that might get managers curious and that will certainly infuriate the tool heads is ‘Kaizen Blitz gets on my…’ (3rd July, West Lothian). Kaizen Blitz interventions are winning awards in Scotland. People know no better. In this event you will see the differences between Kaizen Blitz and systems thinking when applied to the same service (planning). You will see how Kaizen Blitz is attractive to managers (they like the idea of tools) but delivers relatively little change compared to systems thinking. You will wonder why Kaizen Blitz interventions are winning awards.

Tool heads threaten client

The tool heads have been making hay in the health service. Like many systems it is so fragmented that any attention to flow will produce results, but the results are insignificant to the results you’d get if you changed the system. In one health organisation the tool heads have bumped into some Vanguard people. Their response has been to tell the client that if they work with Vanguard they will not get any support from the tools community. Extraordinary behaviour.

If and when the client sees the value of taking a systems approach they will neither want nor need that support.

Womack on sustainability

Many readers have sent me Jim Womack’s latest newsletter in which he laments the failure to sustain a change in a healthcare system. He describes talking to a manager who had ‘Kaizen Blitzed’ the organisation’s key value streams, with amazing results, but the results were not sustained because the change was not ‘connected to the way the organisation was managed’. Things regressed. We have seen the same in the UK. In one hospital, staff ‘went back to the old ways’ and it necessitated a new layer of management to keep them in control. It amazes me that people did not recognise this to be a symptom indicating they had the wrong answer.

Womack’s remedy is to put in value-stream managers who periodically re-audit the value streams, assessing the current state and ‘visioning’ a future state. This is no different from ‘process owners’ in the days of TQM. It didn’t work then and it won’t work now. The answer is to change the system – to change roles and measures so that the people in the system continue to develop knowledge and, hence, improve. Sustainability is a design problem; you have to change the system.

‘It’s a system problem’

This has been an oft-used excuse amongst ministers confronted with failures in our public services. The latest example concerns a woman who died through atrocious out-of-hours care. She made eight calls to the out-of-hours service, talking to eight different doctors. Each call was treated as a separate episode; she had to re-count her symptoms and what had gone on with previous calls each time she called. None of the doctors recognised that she had blood poisoning, which led to organ failure. This tragedy was described as a ‘major system failure’.

The doctors involved were punished, six will now go back to work (having been suspended) following the ‘review’ and two are to be subjected to a performance review by their PCT. If it was a system failure, the doctors should not be blamed, for they were working in the system; they were not its architects.

My guess is this system was designed by someone who wanted to buy transactions, so it was designed to do that. The architect lost sight of the system’s purpose, perhaps driven to do so by the bigger system’s focus on cost. It is the architect who should be held responsible. ‘It’s a system problem’ has become a mantra for avoiding accountability.

We have seen exactly the same in adult social care, every time someone seeks
help they are treated as through they are unknown, each is a ‘new’ transaction. Such designs drive up costs and worsen care. Ministers are responsible for promulgating these designs through various agencies; managers are responsible for implementing them. We must remember every system has a leader and the leaders are responsible for their systems.

More HMRC nonsense

One system that is in trouble, no doubt aided by the tool heads (see newsletters passim), is Her Majesty’s Revenue and Customs. A frustrated reader writes:

‘Just thought I’d share my little HMRC ‘groundhog day’ story. I left the UK for the USA four years ago and no longer have any income in the UK. Every year since my departure I have received a tax return to complete, followed by a fixed penalty notice. Every year I spend time and money calling (never being able to speak to anyone who can help) and writing letters. Every year I eventually get the fixed penalty cancelled and assurance that it won’t happen again, but lo and behold…. received my latest return just last week – only a month after my last fixed penalty, which is still waiting to be cancelled.’

The fact that this happens predictably indicates it is a system problem.

Ambulances making their numbers

The stupidity of measuring the eight-minute response time has been all over the press recently (you get a tick in the box for getting there in eight minutes even if the patient dies). People working in the ambulance service tell me this is causing some managers to send ‘technicians’ who get there on time but can’t help the patients (some die) and other managers work on what calls to ‘exclude’ from the eight-minute measurement. The latter, of course, leaves them open to making the mistake of treating some events as not time-critical when in fact they are.

Both are examples of doing the wrong thing. The right thing would start with understanding demand and capability. It would open peoples’ eyes to the waste in the current service design. But until the ministers get interested in that, the service providers will continue to do what they can to cheat the wrong numbers – wrong in the sense they can’t help you either understand or improve the system.

Cops do the same

A reader writes:

‘My local police force is trumpeting their increased detection figures (these had in the past had been the subject of criticism). The Chief Constable has been on something of a mission to get these percentages up. A senior police officer told me ‘off the record’ that this is being achieved by making arrests and handing out cautions for low level offences, that would otherwise have dealt with informally. So if a teenager gets caught doing graffiti or whatever, instead of having a quiet word with the youth and their parents, he/she is called into the police station and formally cautioned. Result: more police time spent filling in forms at the station, less out on the streets protecting the public. Still the figures look good and the Home Office Ministers are happy! You really couldn’t make it up.’

Choice-based lettings

Another example of ministers driving the wrong behaviour can be found in housing: Choice-based lettings has become a ‘must-do’ change for housing organisations; it includes the word ‘choice’, so it gets the attention of the Prime Minister who believes ‘choice’ is a lever for improvement. In the course of conducting ‘check’ and re-design of voids (empty properties) and lettings, one of our clients learned the government-promulgated scheme is flawed. It is, in fact, a high-cost, poor-service design.

If you are in housing and you want to know why ‘choice-based lettings’ is not the right solution, and you want to know how the systems approach provides better service – yes better choice – and much lower costs, then you should attend our special event on July 31st in Buckingham.

Is the customer stupid?

A reader writes:

‘I don’t know if you’ve had the pleasure of visiting a post office recently? The queues seem to have grown – a lot! I suspect that like me, many have gone in to have their letters checked because, like me, they have no idea how much it will now cost depending on the shape of your letter (or something). The changes in the cost structure seem to have done a great job in generating failure demand for the post office counters business. The straightforward previous system obviously was too straightforward and the post office counters obviously needed more work! Or am I just a stupid customer, failing to understand?’

I think we know the answer.

The Case Against ISO 9000 – in Spanish

I am indebted to Rodrigo Gutiérrez who has translated my book (The Case Against ISO 9000) into Spanish.