Archive for the ‘Management’ Category

Measuring for the right reasons.

March 18, 2013

In a recent article Simon Caulkin gives a vivid description of how it emerged at a recent event on ‘results-based management’ run by the consultancy Vanguard that “what to measure may be the single most important management decision a company makes.”

 For an indication of why, take the case of a typical local authority child protection department which operates to two standard measures. For children at serious risk, it must carry out a fast initital assessment of 80 per cent of cases within seven days. For a full core assessment, the standard is 35 days. The department meets both standards; under the widely-used ‘traffic-light’ signalling system (red-amber-green) it rates a green, so managers judge that no further action on their part is necessary. 

 Now look at the same department through a different measure: the end-to-end the time taken to do the assessment from first contact to completion. The picture that emerges is very different. The urgent assessment predictably takes up to 49 days, with an average of 18.5, while the 35-day assessment takes an average of 49 days, but can equally take up to 138. Worse, the clock for the core assessment doesn’t automatically start when the initial assessment finishes but only when it is formally opened. So the true end-to-end time for the 35-day assessment is anything up to 250 days. ‘Now tell me Baby P and Victoria Climbié were one-offs,’ says Vanguard consultant Andy Brogan, who gathered the data, grimly. ‘They weren’t – they were designed in.’

 When the underlying cause is looked for we find, Caulkin says, that “from assessing and protecting children, the imposition of the government-mandated measures ..has shifted the de facto purpose to meeting the standard within officially laid-down parameters”

Unlike standards, the end-to-end measure on the other hand throws light on how well the department is meeting its purpose. Learning takes place. The workplace conversation is no longer about how to meet the standard but what accounts for variation and how to how to save time in assessments to make children safer. Contradicting the traffic lights, action is urgently needed. As the process is repeated, improvement becomes continuous.

 The “why” we measure must, Caulkin insists, always precede the “what”,  and in the remainder of his article he states very plainly why this must be so.


Box-ticking, bean-counting, target-meeting in the NHSdoctors

March 4, 2013

Here, in a  comment is free  column for today’s edition of The Guardian north London GP and Urgent Care Centre doctor,  Dr Fred Kavalier , gives readers some insights into how the flawed management of which Simon Caulkin wrote on Friday is viewed by someone who has seen it close up.

In today’s box-ticking, bean-counting, target-meeting NHS, doctors and nurses are forced to concentrate on things that can be measured and quantified. In the process, we are forgetting many of the things that really matter – the things that are difficult to count and measure.

From 1 April, when all NHS services will be up for grabs by the private sector, it’s going to get much worse. For all its failings, some of which were highlighted by the recent Francis report into deaths at Mid Staffordshire hospital, the NHS has always had the care of patients as its core activity. GPs and hospitals were all singing from the same NHS hymnsheet.

In the new privatised NHS, many of the players will be singing from hymn sheets written in corporate boardrooms. Every single activity will need to be specified in a commercial contract. If some vital aspect of a service is left out it will not get done, or it will appear as an “extra” when the bill comes in…..

All of  which goes to show that the NHS has been in wrong hands for some considerable time now.

The Mid Staffs NHS scandal – the consequence flawed management system?

March 2, 2013

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.