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- Prevention works
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In a conversation between a Vanguard expert and a leader of an inspectorate, the latter said “Vanguard doesn’t like inspection”. It’s a rational response given I have a reputation for criticising the way inspection works – actually why it doesn’t work. But it becomes a cognitive wall; the mind finds it difficult to question things which are central to what is currently believed. Criticisms of the inspection process are rationalised as not representative, due to failures of people to do as they should or just plain “wrong”. It’s easier – less dissonant – to be accusative about Vanguard (me) than to reflect on one’s assumptions.
All of my criticisms can be easily evidenced through studying care services as systems. That’s what it has taken for leaders of care services to get it, and when they get it they design care services that cost less and do more for people. Leaders of inspectorates would think themselves too far away from the nitty-gritty to have any need to study it; besides, they think they know all there is to know about how it works; many of them worked in care services. But, as Deming pointed out, experience is not the same as knowledge.
Here’s what’s wrong with inspection:
It’s too late
If you do find something that’s gone wrong the system will have two costs: the cost of having done something wrong and the cost of repairing the problem. On top of that you have the bureaucratic cost of inspection for both parties. The defence is that identifying failure will correct and prevent failures but this is not supported by evidence. On the contrary, failures to provide effective care abound; they are systemic.
It’s not valid
Many of the inspection protocols have room for subjective judgement. The psychological impact on the inspected can be severe; many people leave; a few take more drastic action, there have been suicides. The inspected focus on what they need to do to satisfy inspectors, which may have little or no bearing on the quality of service provided. Doing that is demoralising.
It’s based on compliance with plausible but bad ideas
This was my criticism of the Audit Commission which, thankfully, was closed down. In the name of “best practice” the Audit Commission obliged conformance with ideas that were dysfunctional – they drove costs up and worsened services. When the leader of the Audit Commission saw me show examples in a presentation to an audience in London many years ago, he simply avoided me. Later he told me he just didn’t agree with me.
We see the same – mandating bad ideas – today in care services. A good example is “safeguarding”. If you read The Care Act, the daddy of safeguarding, it amounts to many ways of saying we should look after people who have significant needs, so no problem with the purpose. But, as with so much policy, the Act strays into territory on method. Thus what you see on the ground is an administrative bureaucracy employing many people. When you study, you discover that the vast majority of people being processed through the bureaucracy have been inappropriately referred. Many arrive there because other agencies (police, fire and rescue and others) are obliged to refer anyone considered to be at risk and will be to blame if they don’t. The motivation is fear more than concern for people’s welfare. Others arrive there because voluntary-sector providers have no other means to alert commissioners to the need for better provision. Others are already known to care services, some have no need; most are not at risk.
Inspectors want to see the bureaucracy. They don’t see past that and so don’t learn that much of the effort expended is of no value and is wasting public funds. When you identify those who are at risk the majority have previously been referred to care services or are receiving services but because of system conditions controlling current services (specialisation, budget management, thresholds, commissioning, activity, case-load management) they haven’t been helped. As I said above, failure to help is systemic. None of this is visible to inspectors, which is why we learn of failures in services rated by inspectors as good.
And it makes me ponder. Why did we need The Care Act? Is it because ministers were alarmed at examples of people suffering through lack of care? I suspect it was. The Care Act is an example of single-loop thinking – things were going wrong so let’s try harder; do the wrong thing righter. If effort had been placed on understanding why things were going wrong (double-loop learning) ministers would have come to a different conclusion: the problems were created by their policies governing care services.
Ministers since the days of Margaret Thatcher have believed that quality can be achieved through specifications and inspection. They are wrong; all that gets you is conformance. When things go wrong, as they will with conformance to bad ideas, the response is to do more of the wrong thing; more specifications and inspection; more cost, more dysfunction, more demoralisation.
I learned many years ago that quality is concerned with prevention, not inspection. What does that mean for care services? What would we need to know to prevent things going wrong? The first thing is having good knowledge of demand in citizen terms. That leads, in turn, to designing services with the expertise to respond to that demand where the first respondent has the responsibility to establish “what matters” and the freedom to pull relevant expertise as any demand dictates. It means in practice that everyone is seen immediately (unlike what happens currently in “conforming” services) and they get what they need, not what is inappropriately provided through the current specialisation-bound system.
The controls in this design are knowledge of demand, a focus on only doing the value work (the things that matter to users) and achievement of purpose in user terms. Knowledge, expertise and responsibility are the basis for prevention. Inspectors who fear this will lead to anarchy will learn that it actually engenders greater transparency on top of greater control (double-loop learning). It follows that there is no need for a separate safeguarding bureaucracy.
Prevention works. Care services employing preventative designs help more people at much lower costs and demand (failure demand) falls.
If you know any leaders of inspectorates, and they have to be leaders – it isn’t something that can be delegated – we will provide them with help and advice in how to study and redesign care services and from there discuss how regulation and inspection should change in order to facilitate more effective service provision. We will do this for free. Leaders who want to sign up should contact Emma Ashton: email@example.com
To get a flavour of how this works you can encourage them to watch this recent webinar:
Another example of single-loop thinking is the current health minister crowing about an app that lets people see the waiting times at Accident and Emergency services in their area. The reason for demand problems in A and E is the ineffectiveness of health and care services, studying reveals how the few (who aren’t getting help) consume the greatest resource. Why are health services ineffective? Because of the system conditions rained down upon them by Whitehall. The app is doing the wrong thing wronger, but it fits the minster’s narrative.
Gary Hamel – the world’s most expensive management consultant – laments the growth of jobs in what we call the management factory, everything sitting above operations. Back in the 60s Peter Drucker believed the number of management roles would fall as knowledge-work increased. He should have been right. But instead the management factory has increased both in terms of size and control.
Top of the list for exerting dysfunctional control is budget management. Invented by James McKinsey (yes, really) it is the skeleton on which all other control systems hang. While there is wide-spread recognition that budget management is a problem the current remedies amount to no more than single-loop thinking, doing less of the wrong thing is not to do the right thing. Second, in terms of importance, is Human Resources whose policies and practices are responses to the dysfunctional consequences of command-and-control management.
In financial management we have learned that the right thing (double-loop learning) is to focus instead on how operations generate and consume money. It dissolves the problems of budget management. With HR the first step in double-loop learning is to help HR professionals see how their people practices focus on the 5% (the people) and how it’s the system (the 95%) that governs performance.
We’ll be talking about this work and giving attendees practical things to do to get started at our up-coming Masterclass.
Our other latest development is helping clients undo the problems created in the blind rush to digitise services. The cult-like belief in Agile, Scrum and other new-name fads (e.g. SAFe, meaning Scaled Agile Framework – note the redundant ‘e’, making it sound sexier than it is, SAF wouldn’t sell) operating in the ‘go digital’ space is without foundation. I know of many large-scale enterprises where top management are at last starting to question whether their massive investments in digital and Agile et al are baking bread.
As well as undoing the damage (e.g. digital services that only serve to increase failure demand in service centres) we are helping them work out what services can work via digital means, what can’t and, by helping them study and redesign services before any digital developments occur (IT last, not first), we enable them to design digital services that knock their customers socks off.
We’ll be talking about our work on budget management, HR and digital services at the Masterclass. As preludes we’ll also cover how the Vanguard Method was developed, take the audience through the basics and show how it works in detail with a large-scale-organisation example. It’s on June 20th near Birmingham airport. Do come! If you’re broke write to me to get a concessionary ticket J.
More information here.
If you want to know more about studying and redesigning services, removing current controls and establishing better controls, join our Beyond Command and Control Network – it is free to join.
If you want to get cracking with the Vanguard Method we provide a development and accreditation service for both in-house practitioners and consultants. It gives you access to a Vanguard expert who will help you develop, and acknowledge, your competence in applying the Vanguard Method. Contact Toby Rubbra: firstname.lastname@example.org
Thanks for reading!