There was a terrific piece in last Friday’s edition of The Guardian by Simon Caulkin auggesting that ‘NHS management failures stem from the same flawed system that gave us Enron and Lehman Bros in the private sector’
The Mid Staffs NHS scandal will not go away. The collapse of the hospital trust into administration and the subsequent resignation of two board members. ensures that the wound will continue to bleed, ratcheting up the pressure on the embattled NHS chief executive Sir David Nicholson. Investigation of suspicious death rates at a number of other hospitals just increases the sense of foreboding.
One reason that scandals like these both run on and recur is that we persist in thinking of them as exceptional; one-offs caused by a few incompetents or rotten apples in an otherwise wholesome barrel. But they’re not. The terrible outcomes at Mid Staffs were the logical consequence of a disastrously flawed management system that systematically forces people to face in the wrong direction, counts the wrong things, and focuses management attention on the wrong part of the job…….
What’s flawed about the system is, according to Caulkin, performance management, which was originally presented as “an enlightened expression of shared interest’ has in reality “morphed into its dark opposite, synonymous “not with developmental HRM and agreed objectives but with a claustrophobically monitored experience of top-down target driven work”.
Applied to individuals such tactics lead directly to Mid Staffs, a system which reshaped people into target-chasers who couldn’t afford to care. At the level of the supply chain the same kind of fierce control gives us a different form of butchery. Scaling up the performance-management tyranny, the big supermarket chains treat meat suppliers as adversaries, writing short-term term contracts, playing one off against the other and driving prices way below the point where something had to give. The immediate result was horseburgers. But behind the scenes is a much bigger, very British tragedy: a meat industry that is in long-term crisis and decline, wholly unable to defend itself against less cannibalistic European counterparts.
Anybody who has read Caulkin over the last 20 odd years, as I have, would expect him to end on an upbeat note. Much of what he has been saying in that time has gone wholly unheeded. Why should things be different now?
Few these days would want to be treated with the mixture of superstition, ideological prejudice and pseudo-science that constituted medical knowledge in the Middle Ages. But that’s hardly an exaggeration of the state of management today. It is management not medicine that has put our institutions in intensive care, and until we decide to do it better unfortunately that’s where they will remain.