Business in the rear-view mirror

Would you drive your car, whilst looking only in the rear-view mirror?
I thought not…yet this is common practice in business, education, and government, where historic performance data such as quarterly reports and comparisons with ‘this month last year’ are widely held to be meaningful.

The noted US engineer and scholar Dr Myron Tribus famously wrote of this as: ‘-like trying to drive a car by watching the yellow line in the rear-view mirror.’
And I for one would not wish to be a passenger in a car driven that way!

My attention was drawn here by a Tweet: > @kvistgaard RT @tetradian: RT @jdevoo: Walking in Allende’s Footsteps: Cameron’s No. 10 Dashboard nyti.ms/UfOwnv #cybernetics #entarch #vsm

< A recent Civil Service article expresses pride in the achievements of a young fast-track officer, who had created a ‘dashboard’ application for the PM’s iPad.
‘One of her recent projects…was designed to give the Prime Minister, other Ministers, and senior Whitehall officials an at-a-glance overview of everything that’s happening in government and elsewhere…with a few taps or swipes of his fingers, he can see very quickly what important new information has come to light, how certain government services are performing, and a selection of relevant and important news reports.’

I accept that in politics a craving for sound-bite sized facts is a cultural constant, and may be an itch that highly visible leaders cannot leave un-scratched. My complaint lies not with the politicians, but the shallow presentation of data. I’m pleased that intelligent politicians want to track data, but concerned that this format invites incorrect interpretations.

Look at an example: http://publications.cabinetoffice.gov.uk/assets/images/strategy/case-studies/fast-stream/Alice–GDP-ret.png -look solely at the last 5 points in a hopeful frame of mind and you might see a strong rise; but search for an overall trend and do you see an upward shift? This really is just a pretty picture, since no matter how many points of that wiggly line are drawn it provides no explanation.

Since the diagram does not explain WHY things happened, this trace is not helpful to PREDICT what may happen in the near future -which is the main route for those seeking to understand and improve performance.

Without using theory “Perhaps it is a 70-year cycle?” to link events with causes, these snapshots and zig-zag plots cannot tell us any more than that the situation is volatile.
We need users to ask “What happens next?” shifting the emphasis from home-spun guesswork “Yes Sir Humphrey, figures do seem to be rising” –but are they really? –can we tell whether this really is a normal swing, or a fluke? –and does the cause lie inside the work, or is it driven from outside?

Thus an emphasis on prediction has to become a key task for management. Sadly this dashboard is not about prediction –and as a passenger in the car, I’m becoming worried…

Why targets are not helping the NHS to improve

An event by the Deming Alliance - Monday 11 April 2016   09.30 – 16.15

The Round, Nettle Hill, Brinklow Road, Ansty, Coventry CV7 9JL

www.nettlehill.co.uk   Google map http://glurl.co/jTl    Rail: 15 minutes taxi from Nuneaton or Coventry

 

OUR FOCUS will be on the management of healthcare in general and the NHS in particular, drawing analogies and comparisons with the ex-Soviet system of healthcare management.

Topics include:

  • Current healthcare management thinking vs. ex-Soviet healthcare thinking
  • The use of numerical targets (including deadlines) as a method to increase performance
  • Interpreting indicators (especially flowcharts)
  • Managing and understanding hospital (NHS) budgets
  • Procurement and contracting

THE PARTICIPANTS

Do you work in healthcare or the NHS in the UK?     Are you interested or involved in performance improvement? Are you concerned by the need to improve quality while under pressure of resources?

The seminar will be particularly valuable if you are a junior doctor, a departmental head, a Trust Board member, a CCG lead or an advocate of patient healthcare rights.

There will be contributions from other Deming Alliance members, followed by a discussion on the way forward for the NHS, developing a strategy and identifying concrete next steps.

Alliance host for the day: John Morgan

ATTENDANCE FEE   £45 includes tea & coffee breaks, and buffet lunch.

To book email Secretary, Brian Leeming  brianwleeming@gmail.com

 

THE CONTEXT

Healthcare organisations around the world set their focus on improving the patient experience, and the use of targets has become the normal way to approach this (eg introduction of business plans, Quality & Outcomes Framework for primary health care, cancer waiting times etc).

Logically, it seems to make sense. People know what to aim at; objectives can be measured to show progress and achievement (“if you can’t measure it, you can’t improve it”); and healthcare workers can be held accountable to increase their performance and productivity; and to maximise cost-efficiency.

But have you ever felt that this way of working isn’t working, results are not real, and everyone is chasing their tails?

We stretch to meet the latest set of evidence-based targets, while previous versions become neglected.

Managers incentivise staff to perform, one group distrusts the other, and care levels and cost-savings don’t improve overall.

In a participatory way, the speaker will share and discuss lessons he has learned on improving the performance of health organisations & projects.

THE MAIN SPEAKER

Peter Campbell, a British GP by background, now works as a Consultant in International Public Health Management.

He has 20 years experience working to design, implement and evaluate small and medium scale health projects in developing countries. These include (alphabetically) Albania, Bangladesh, Ethiopia, Indonesia, Kazakhstan, Kosovo, Malawi, Mongolia, Morocco, Tajikistan, Turkmenistan and, particularly, Uzbekistan where he lived for 8 years.

In 2009 he completed a full-time Masters (MSc) in International Health at Heidelberg University, Germany. Since then, in addition to his consultancies, he is lecturing to Master and PhD level students at Heidelberg University, and runs his own courses in Project Design and Health Financing at the Charité Medical University, Berlin.

Peter is also the Team Leader of a €27 million project to develop 16 hospitals in Uzbekistan on behalf of the German KfW Bank.

-ends-

 

 

 

What are Managers for? (one more time)

Despite the ongoing professionalisation of ‘management’ as a distinct line of work, some questions remain too often unanswered.

A key one is ‘What IS the main task for any manager?’

If we wind back the clock to the 1950′s and 60′s we find that a wealth of research was going on to answer this problem, even though American industry and society appeared to still be riding the crest of a wave. Amongst the researchers was William B. Given, who was President of American Brake Shoe Corporation.  Note that Given was not simply a practitioner, but also a graduate of Yale and MIT.

Given’s book Bottom-up Management: People Working Together published in 1949, was well ahead of its time.  Peter Drucker cited Given’s book in his The Practice of Management (1954). And it was following a visit to American Brake Shoe that a business school student championed the refreshingly pointed term ‘Bottom-up Management’ to a wider audience.

According to Given, a good manager had to be a team player; yet like the captain of a sports team -not necessarily the best player-  he had to be a leader; and also to exert a moral influence.  Beyond the formal delegation of authority that was normal in the 40′s, he argued that each manager should deliberately pass elements of his own responsibility for decision-making down the chain, calling it ‘progressive decentralization’.

In both practice and in print Given pressed for personal freedom to be passed on to superintendent staff, ‘-to venture along new and untried paths; freedom to fight back if their ideas or plans are attacked by superirors; freedom to take calculated risks; freedom to fail’ - and according to the brothers Hopper (in their brilliant book ‘The Puritan Gift’ detailing the rise, and decline of Puritan values in North American enterprise) this is the genesis in print of ‘Bottom-up’ which today is a term given (sic) too little credit.

Oh how I wish more of today’s business school teachings took account of this strand of thinking…yet the concept that ‘Managers know what is to be done; and how’ persists in splendid isolation, and so is well beyond its use-by date.  Of course the two are polar, and the truth in any situation will lie in experimentation and establishing a reasonable balance between the two.

Hence my plea to managers, their directors and (long-suffering) staffs, to practice both top-down and bottom-up patterns, according to what works well.  A little open-minded experimentation will quickly prove the worth of the blend, and results will follow.

 

Rock, Paper.

I remember that as small children we never played ‘Rock, Paper, Scissors’ -simply because we’d never heard of it. This was the 1960′s, see, when TV showed grainy pictures in black and white and broadcasts were made only for a short part of the day; probbaly these things combined to slow the impact of US culture on British kids.

Now we didn’t know (or care) that those things were holding us back, and simply played with the toys that came to hand. However we grew up to echoes of parental coaxing “If you ever want to BE something, you have to work harder!”
And naturally we didn’t reconsider that line…we accepted the received wisdom or fatalism of the age,
the ‘shit happens’ school of thought, where you either -A- tried your hardest, and that might (only ‘might’) be enough; or -B- you would fail.

But across the Pond, one rebellious American professor was already famous for asking ‘Wwhy can’t we do things differently?’ and coming up with surprising and effective answers…his name was Russell Ackoff, and years later he wrote of a third way (no, not political rhetoric, but a different worldview of problems). In ‘The Art of Problem Solving’, Ackoff argued for a distinct third approach to problems, not to attempt to merely reduce them and settle for an fair fix; but to Dissolve or wholly remove them.

His third way was a powerfully different approach, every bit as radical as yet-unseen new products like colour TV; Doctor Who with a detailed plot and dialogue; or personal computers would have been to the ignorant, happy urchins of a Cheshire town. Whilst we would have welcomed more and better telly, Ackoff’s legacy has since expanded our take on life; instead of playing ‘Rock, Paper’ we now have three options -and the Scissors wins!

Creating buy-in

In talking this week with Debra, one of my new American friends, about leaders creating ‘Followship’ the subject of ‘Employee Engagement’ (EE) came up. Although EE is widely practiced in projects to bridge a void in the contract between staff and leaders, I had not thought much about what it represents.

Referring to a military example of strong employee buy-in, Debra suggested that it is often better to build employee support for a vision without all the funding in place; than to merely accept a funding stream and then change the direction of teams to follow it. I readily agreed with this emphasis on followship, saying “Right -you can’t buy buy-in.”

What I came away with was a thought that whilst Employee Engagement may be just another fad, it fails to answer an underlying problem; no, not the nuts and bolts of creating buy-in, but asking ‘Why don’t our organisations naturally allow staff pride in work, and grow joy and ownership that render EE unnecessary?’

I’m pretty sure that the problem is the way we run organisations, split along functional lines that do not relate to the real work, as top-down hierarchies with multiple purposes that divide staff, and involving staff downstream of decision-making instead of pulling in their expertise up front.

Whistleblowing ain’t easy

I’ve been reading an example in today’s ‘USA Today’ newspaper of how difficult it is to go against a damaging culture, in this case alleged serious fraud in US government property arm, the General Services Agency.

Many of us know at an intuitive level when things are very wrong. Elaine Johnson says: “Moral behaviour is hard-wired into the human brain.” -however the rub for the would-be whistle blower is that acting on what we know to be right is tougher when the consequences for one’s employment are severe.

Reports to federal committee hearings say that an executive had fostered a culture of ‘putting people down’ who objected to his spending decisions. Apparently the official’s spending habits extended to taking a nine-day visit to Hawaii to attend a one-hour ribbon cutting. One employee told the Inspector General ‘he squashed someone like a bug’ for speaking out.

However oversight since the inspector’s report of May 2011 suggests the matter is a deeper problem than one person’s bad behaviour, with evidence to federal committees suggesting that lavish spending after the release of the inspector general’s report points to a ‘-culture we are going to get to the bottom of…a culture of fraud’

And once the behaviour has spread widely, being a whistle blower is a whole lot harder again. Dr Deming wrote: ‘Fear invites wrong figures. Bearers of bad news fare badly. To keep his job, anyone may present to his boss only good news.’

Beyond the alleged fraud, such a climate of fear damages the lives of all people it touches. There lie hidden and possibly greater costs than those exorbitant purchases, because they are largely external to the organisation, and not costed to the accounts.