Freedom from Command and Control

At the time of sending this, my new book is only a few days away from printing. In it I reveal the fundamental flaws in command and control service designs and give copious examples of analysis and re-design using systems principles. If you buy it I hope you like it. If you do…. tell your pals, if you don’t or if you have views on how it could be improved… please tell me.

The minister should be in the dock

Last month I spoke to the Police Superintendents annual conference in a debate. On the day I sent out a press release saying: The Home Secretary should be charged with wasting police time. Well it amused me. Our police spend so much time meeting the requirements of the specifications and inspection regime rather than doing the business. If you’d like to read a transcript of what I said send an e-mail to: and ask for a copy of the police speech.

ISO 9000: the end is nigh

A reader writes:

“I wonder if you’d read an interesting snippet in the latest edition of Quality World? To paraphrase: 6,000 UK firms have formally confirmed that they will NOT be transitioning over to ISO9000: 2000 (cue mock astonishment, after all, if ISO9000 was really delivering the benefits it claims to etc etc). Of the remaining 61,000, only 16% (as of Dec 2002) had successfully transitioned.

As you know, the remaining 84% (51250 firms) *have* to transition before the end of 2003 else lose their ISO9000 certification altogether. It doesn’t take a genius to envisage either a total collapse in transitions by the deadline (or more likely a desperate, panic stricken extension at the eleventh hour). Or – at a transition/registration rate of 200 firms every business day in 2003 – we’re currently in the midst of the biggest (and most corrupt) rubber-stamping exercise in history.

Keep up the good work.”

I think we should toast the demise of the brutal Standard.


NHS ‘Direct’?

A reader writes:

“In bed last night, I was nearly asleep and felt something touch my hair. I moved my hand to figure out was it was and felt a very sharp pain. Suddenly, I was no longer nearly asleep. I switched the light on and looked around the pillows because I thought I had a splinter in my hand. I couldn’t understand how I could get a splinter from a pillow. Then I put my glasses on and, as I did this, saw a wasp on the carpet near the bed. After the wasp was safely out of the bedroom window, and as I was on my own and have reacted badly to insect bites and stings in the past, I called NHS Direct. After two handovers, duplication, validation (which is not what you need at 11pm when you’re tired and in pain), over-specification and delay whilst I waited for a third person with medical expertise to call me back, I spoke to Cheryl, who was very helpful and talked to me for ages to find out what happened, what symptoms I had, medical history, treatments that I’m allergic to etc. So, value created at the point of transaction, nil, because I had to go through all that crap before I could talk to Cheryl, but very happy once she called me back. Cheryl told me what to do to reduce the swelling and redness and when we finished the call and I’d done what she suggested, I fell asleep reassured that everything was OK. This morning, when I was on the train to Leeds, I noticed this:

‘NHS Direct takes its time’ Resolute nurses are insisting on giving NHS Direct callers the time they
believe they deserve, reports Nursing Times (September 10).

A survey from King’s College London says that while there is no official rationing policy regarding the time NHS nurses spend on the phone, pressure nonetheless exists.

Callers gave NHS Direct the thumbs-up for its ‘user-friendly’ approach and the time allocated to their queries. […]’.

Hmmm. Time allocated to queries – yes, but ‘user-friendly’ approach – I
don’t think so!”

Maybe they should call it ‘NHS indirect’? Or ‘NHS eventually’?

A visit to the Modernisation Agency

I was invited to take a look at what was going on in the NHS Modernisation Agency. I spent two days at a ‘learning workshop’. It is an ambitious intervention, bringing together groups of people in like disciplines from all across the NHS to hear about good things, share what they are doing and so on. I was impressed. There were numerous good examples of service re-design. Sadly they are not supported by the system. In particular there are major issues with roles and measures. People do what they do despite the system. They should be applauded.

Disquiet about targets is not encouraged, they are taken as a given. On day two when Professor Sir George Alberti was in the hot seat, the targets issue came to the surface. Well-reasoned objections from the floor were greeted with: “You can have all the flexibility you need, provided you make the targets”. I was saddened to witness someone knowledgeable and wise in his own field make such an ignorant and unthinking statement. I left. I’m going to send him a copy of my book.

People in the NHS are crying out for good leadership. They are not getting it from the incumbents.