Can you trust your doctor?

A disturbing story that apparently appeared in the news while I was out of the country last month: General Practitioners are being awarded financial incentives for getting their young patients inoculated with the MMR vaccine. Some mothers still have doubts that have, no doubt, been fuelled by the press coverage. To make their money some GPs take the patient off their list. They tell the mothers not to worry but the mothers then get a letter from the local health authority confirming their family is off the list. And worry they do. Taking a small number of youngsters off their list can reap a significant return for the GP, by upping their percentage from 80 to 90 they get thousands more pounds. Whose idea was it to inflict such damage on the doctor-patient relationship? I think you know the answer. In an attempt to prevent one epidemic, government creates another – an epidemic of mistrust.


Systems thinking in the public sector – a public event with the Vanguard team

Want to find out what we have learned working in the public sector? Want templates for improving public sector services? The starting-place for change is to understand the ‘what and why’ of current performance as a system. At this event we will give participants the system pictures we have developed in a variety of public sector processes – from planning applications to the criminal justice system. You will see for yourself how and why these templates get results – and you might be amazed at the extent of some of the improvements.

The agenda will be posted on the web site during March. The date is June 6th and the venue is in the Midlands – close to M6, M1 and north of Northampton.

Remember the Prime Minister said: ‘What matters is what works’. Come and find out what works and why it works.


The PM shoots low

The British Prime Minster said on T.V.: ‘Our public services should be every bit as good as our private sector organisations’.

Sad that he shoots so low. Even sadder that this kind of talk leads our public sector organisations to be bludgeoned into being duped by the promises of the large-scale change merchants. Would you want to tell the PM he has the wrong idea? So public sector organisations follow the empty promises of those who seek to sell them IT infrastructures, culture change programmes and the like. None of the providers has good methods for change. They are more pre-occupied with selling what they have than helping the organisation gain knowledge about the what and why of current performance. Of course if they did this, they might sell less product.

Someone needs to tell Tony the private sector has a bunch of problems – all caused by the very paradigms he and his ministers wish to foist on the public sector. Perhaps the UK civil servants who receive this newsletter will oblige…?


More ISO 9000 b*ll*cks

A correspondent writes:


During the recent farce – otherwise known as ‘The annual BSI Audit’ – our auditor recorded an interesting observation:

‘It would be beneficial if each procedure in the QMS referenced the ISO9000:2000 clause(s) that it addresses’.

Hmmmm. Two questions, I said: ‘Firstly, our QMS has ~900 documents. How much effort would be required to update each of them? More importantly, how would our business benefit from performing such a task?

His answers were, well, somewhat unconvincing.

This suggestion may have proved ‘beneficial’ – but only to lazy ISO9000 auditors who want to shovel yet more inane bureaucracy in the direction of business.

At least we realised the consequences. I can’t help but wonder how many organisations would have actioned the observation? I hope that this was an isolated example…though I suspect it isn’t.

Keep up the good work.

I’ll do my best 😉


The costs of ‘make and sell’

I received this e-mail from a fellow systems thinker:

I had a chat with my brother-in-law who is an auditor for Vauxhall UK. He has just purchased a car for my sister ….. a brand new Corsa. She ordered a base car with a factory fitted sunroof, however she received a car with factory fitted Sunroof and full electrics (windows, doors, mirrors and PAS). The reason is that the only cars they have available with a factory fitted sun roof are cars that are due out to the market in May, yes MAY which will have the higher spec. The questions I posed to my brother-in-law were how much cost have they given away to my sister? What is the cost of storing all these cars and their subsequent inventory? and how did they plan to sell the two things (electrics and sunroof) together? Marketing was the answer: ‘We’ll do a special deal on this car in May’.

I said that this was just adding another cost in chasing demand that wasn’t there. He started to open his eyes. ‘How would you do it another way?’ was his question. My answer was that I would only build cars that people wanted to buy, that his team would no longer have a role or be a cost, and that he should read some stuff on systems thinking and pull production as a starter.

In the mean time if people want a car with added value then order a Corsa from a main dealer and ask for a sunroof, I guarantee they will get the electrics pack too.

I had to tell someone who would understand!

It reminded me: I heard on the grapevine Ford Europe is reluctant to take away the ‘revenue out the door’ measure on their factories. Without doing this they will never go lean – despite paying huge sums to some Toyota-trained sensei they have working there. My informant told me they don’t think the City would be persuaded.

Denise Toscani, of Vanguard Scotland, has just been in a meeting with a manufacturing client and their bankers. The bankers were so persuaded of the benefits of lean that they agreed to fund the company as it continues through the change.

One of the problems is that inventory appears on the balance sheet – but even bankers can be persuaded of the folly of that idea. Maybe Ford Europe should give Denise a call 😉


The simplest changes are the hardest

While describing the work we do to an executive committee, it occurred to me that the simplest changes are the hardest. It takes only a couple of days to understand the ‘what and why of current performance as a system’ of a customer service centre. To change performance and morale takes two to three months for a centre of about 300 people. By comparison in a more complex system – for example engineering services – it takes about three weeks to understand it and six months to change it. But the peculiar thing is: it is easier to convince managers in more complex systems of the need for change to a systems perspective.

Perhaps it shows how deeply engrained managers of service centres are in the wrong thinking. Maybe this is because, unlike their engineering counterparts, they never connect with the work. Waste in engineering is palpable. Waste in service centres designed on the usual ‘production’ principles is enormous but invisible, until you take a systems view, and then it jumps out at you loud and clear. Maybe the ferocity with which it jumps out scares or embarrasses them?

On the other hand, maybe these service centre managers feel threatened at the prospect of standing out from the crowd. Safer to play the current game; safer to stay in management land. Deming used to say: ‘Doesn’t anybody care about profit?’ What stops managers caring about profit? Your views…?