- More on the chiefs
- Demand the evidence
- It’s worse in the health service
- Ideas will be punished
- Audit Commission follows Vanguard tweets
- Factory managers compound their mistake
- Economy is in flow, not scale
- Lean is a wicked disease
- Lean is everything
- Lean is everywhere
- Pretenders screw up
- Is procurement a profession?
- The risk is letting the nutters loose
- The other nutters
- Good news for children’s services
- What got you curious?
- Some dates for your diary
Following the item about me bombing with the county council chief executives in last month’s newsletter I received a lot of mail along the following lines. One reader sums it up:
‘I have to say I am not surprised you had a hard time from County Council Chiefs. There is a complete industry around shared services which seems to have an unstoppable momentum. Our County Council has formed a ‘Better Together’ project board with representatives from each district council. They have appointed (at considerable expense) a project manager (with an assistant) who has produced beautiful Gantt Charts resplendent with every colour of the rainbow and full of meaningful symbols. There are carefully calculated savings extrapolated into the future. The only thing lacking is, er, a project, as few, if any, of the districts think that there is any benefit to be gained from sharing services.’
That’s it. Call it ‘better together’ and who would argue with that?
We should all demand the evidence. The experience of shared services is like a series of train wrecks. As the big idea behind them – economy of scale – has been promulgated by economists, I thought I’d research the economics literature for any evidence. There is none. The arguments for scale in the economics literature amount to a mixture of the palpably obvious (e.g. one building is cheaper than two), a little – and only a little – hard data from pioneers of specialisation of work in manufacturing and these are used to build some general but unproven arguments. Pretty shocking really. In fact I am so shocked that I have decided to write an article on why is it that we believe in economy of scale; and why we shouldn’t. I think I should send it to the county council chiefs.
The following letter from a reader confirms something we are learning this year; the health service is even more dysfunctional than local authority services. He wrote:
‘I first picked up your seminal book ‘Systems thinking in the public sector’ whilst completing my dissertation for an MSc. Suffice to say it was a life changing experience reading this and then ‘Freedom from command and control’. My job at the time, working in Performance Management in a local authority, provided me with lots of real examples of how systems thinking could sustainably improve performance – but alas I was told to stop rabbiting on about systems thinking and get the myriad of pointless BVPI action plans completed by ‘accountable’ officers (which I knew by then was as wrong-headed as you can get).
I took what might now seem a stupid decision to move out of local government and back into the NHS where I had worked some years before. Armed with my knowledge of systems thinking and the unintended consequences of targets, I thought I would have some challenge to my ideas – but not to the extent that I have witnessed in the first 6 months. My job is nothing but targets, ensuring we have the right level of activity to achieve target levels of income and to develop extensive programmes of productivity and efficiency savings. But if I suggest Systems Thinking methods, I am shot down and reminded that the NHS is a complex organisation. I know there is so much waste it is almost laughable because, for example, there is a team of ‘trackers’ specifically dedicated to ensuring the 18 week referral to treatment target is not ‘breached’ otherwise the Trust is fined.’
The ‘trackers’, ‘bed managers’ and other forms of management progress-chasing are indicative of the ills in the health service. These roles tamper with the system, tampering makes performance worse. Over the last year we have begun to research the health service as a system and, in short, it is shocking, more shocking than even we imagined. Just two examples: Managers encourage clinicians to do anything (like take blood) to enable the system to say this patient has started treatment. Once the patient has ‘started’, he or she can be bumped from the treatment queue in favour of another who is about to ‘breach’ their waiting time. Secondly, managers encourage clinicians to treat those patients whose condition attracts greater revenue, effectively putting them forward in the queue. These things are immoral. Who should we blame?
A reader writes:
‘I work in a government agency. Sometimes management’s shenanigans make my eyes water. Surplus managers have nothing to do so they invent new and exciting interventions to ‘improve’ things (in a department of around 40 employees there are 10 supervisors and managers). At the same time employee suggestions for improvements are treated as an unprovoked physical attack, and results in a permanent exclusion from any serious consideration of advancement of any sort.’
The really disturbing thing is that we have created a generation of managers in the public sector who actually believe the centre must be right; they are cronies of compliance, advocates of the ideologically plausible and bullies to their staff.
Of course one of the devils in this mix is the Audit Commission. Vanguard people who tweet tell me people in the Audit Commission are following Vanguard tweets. Maybe it is a ‘know your enemy’ strategy? I sense the axe falling, it won’t be too soon.
One local authority that has gone big-time for factory working – call centres and back-offices – has just introduced something called a ‘graded response strategy’. In an attempt to manage the queues and reduce the costs of transactions, ‘simple’ transactions are to be handled at 1st response while ‘more complex’ enquiries will be queued and handed to ‘specialists’ in 2nd response. Really ‘complex’ calls are passed to specialists in the back office. As the reader who let me know said: ‘Triple queuing fun!’
We can be confident that the service will be worse and the costs higher. But managers will get their stars (in fact this council is one of the ‘best’ according to Audit Commission goons).
The reader tells me that some managers are resisting the move, as it entails losing staff to the factory. The managers argue (rightly) that the benefits case is spurious. But my bet is compliance will win over evidence. Their problems with getting calls answered is, undoubtedly, due to rising demand, which should have been a signal. Instead of recognising it as a signal and studying demand to learn more, their actions will create yet more demand. Bonkers.
We continue to produce evidence that shows how local services are better services, better in delivering what citizens need, at lower costs, and with staff who are proud to do a good job. I put some of the evidence and arguments into a paper published by Localis, a think tank. You can read it here:
I wrote an article attacking ‘lean’ for a web-based magazine called BNET. It drew a response from a lean practitioner, defending lean (‘it’s OK if you do it right’). As it happens he has a blog. On it he calls for people to engage in his latest ‘lean’ initiative: to reduce time spent in meetings. You couldn’t make it up.
You can read the article at: http://blogs.bnet.co.uk/sterling-performance/2010/05/17/john-seddon-why-lean-is-a-wicked-disease/
A reader wrote to say his wife was at a presentation on ‘lean transportation’. It amounted to working out optimum speeds for lorry driving to maximise petrol usage. Apparently the presenter didn’t like the question she asked: ‘Why is this ‘lean’?’
Lean has been a big fad in the health service. An internet blog crowed over a ‘lean’ initiative in a pharmacy. The tool heads had worked out which drugs were supplied most often and moved those to nearer the counter. It is something you see in manufacturing, it cuts down the time it takes to pick items in warehouses.
A systems thinker joined the blog to say that he had just been studying a pharmacy and found the biggest problem to be incorrect prescriptions. Doctor’s handwriting, incorrect dosage and wrong drugs being some of the problems. The pharmacists knew they had to work up-stream to create real improvements. It makes the point you could make with just about any lean intervention. The tool heads do the wrong thing righter, the systems thinkers get knowledge to determine the right thing to do.
Vanguard’s unique contribution has been the creation of a method to help organisations change from a conventional ‘command-and-control’ design, to a systems design. Because it works so well we have created a market – all sorts of people have popped up claiming to offer systems thinking. It takes us at least a year to train a Vanguard consultant; they have to learn how to work alongside managers as the managers employ the method.
The pretenders won’t have our method, and, as I have said here before, perhaps the best way to spot a pretender is to ask them about their method of intervention – training people in ‘systems tools’ is an obvious indication that they are purveyors of the wrong answer.
But of course training in tools appeals to managers. And so it has been in three cases reported to me last month. Managers bought ‘systems thinking’, did their training, set up their projects and it failed. So now they think systems thinking doesn’t work. They just got duped by a pretender. Tragic.
Last year I spoke to an audience of public-sector procurement people. My theme was ‘is procurement a profession or an operational issue?’ I talked about how in the guise of being ‘professional’, procurement people buy bad deals. The latest to come to my notice is in the procurement of housing repairs services. Repairs organisations that have halved their costs while improving their service and thus represent incredible value for money, don’t get a look in because the procurement professionals can’t tick their boxes.
Totally bonkers. The thing we should avoid buying is the idea that procurement is a profession.
A reader writes:
‘I work in a software company, ‘blessed’ with ISO9001 and TickIt. Recently our quality manager decided we need to do ‘risk assessment’ and this apparently means following the FMEA toolset. Putting aside my surprise that he thought this was an activity we didn’t already do (for who does not think about actions, consequences and risks?), and the wisdom of trying to put precise numbers on unquantifiable possibilities (or indeed doing this on paper rather than face-to-face), I restricted myself to just two questions: First, I asked what the evidence was that we had a problem with risk. Second, I asked what the evidence was that FMEA would help.
He said that the evidence of problems with risk were an auditor’s report highlighting unspecific ‘concerns’. So now auditor’s opinions have become factual evidence. He then said that ‘FMEA has inherently un-measureable effects’. In other words there’s no way to tell if it does any good, but we’ll do it anyway because we have to and you never know, maybe it does help.’
Clearly the risk is letting nutters like this loose in our organisations. Just as the public-sector has done with the Audit Commission.
The other nutters are the targets brigade. I mentioned our studies in the health service earlier. Here you will find plenty of others describing how the two-week cancer target is creating dysfunction:
We must hope that the new government doesn’t make the same mistakes. Time will tell.
Professor Eileen Munro (LSE) has been appointed as an adviser on children’s services. I have met her and she is fully aware of how the integrated children’s system (sic) has been at the heart of the problems in children’s services. She has promised to ‘wipe the slate clean’.
Describing the last government’s fiasco she said: ‘They brought targets and indicators into a relationship-based service. Once they realised the targets were having an adverse effect, they put in other targets to try to counteract it. So it went on until we’ve reached the point now where professionals do things to keep government happy and are not focused on how to keep a child safe and happy.’ See: http://www.communitycare.co.uk/Articles/2010/04/27/114370/tory-advisers-plan-to-cut-red-tape-in-child-protection.htm
We know that for most people, getting interested in systems thinking started with something that made them curious. For example, I just met a leader running an insurance-claims business. When a man who did the repair work told him how long it actually was between the customer having a problem and the repair man turning up, it started the leader off.
We have been talking amongst ourselves about this and we have decided it would be interesting to do some research. So if you can recall what first got your curiosity aroused for systems thinking and you have a moment to write it down, we’d be delighted to include it in our research. Please send ‘what got me curious’ to Charlotte Pell: firstname.lastname@example.org
24th June – NLGN/LGC conference: ‘Welcome to A New Government – A new era for local authorities?’ I shall be speaking at this event – an opportunity to talk about whether the new government is going to be different from the last when it comes to public-sector management. Information here: http://www.lgcandnlgn-newgovernment.com/
9th September. The Association for Public Sector Excellence in Derry, Northern Ireland. APSE has taken great interest in systems thinking – they have seen the evidence. This is a good opportunity for those of you ‘across the water’ to hear more about what systems thinking is doing for public-sector services. For more: http://www.apse.org.uk/service-awards/index.html
25th November. Systems Thinking: the Leader’s Summit. I shall be hosting a summit featuring leaders who have used the Vanguard Method to achieve outstanding transformations, telling how it is, warts and all. The contributors will be from both the public and private sectors. Keep the date, more news later. To pre-register email email@example.com