Based on the brief encounter we had with him, a few weeks ago, we know he’s something of an ‘Alice-manager’...
... fond of disappearing down rabbit holes.
His efforts to solve NHS’ sclerosis, by collating ambulance handover times, sent him off, on a wild-goose-chase, looking for the causes of variation. Why some ambulances wait longer than others.
Variation is the enemy of quality but not always is it the case that variation is either causal or a solution to problems. Variation is a result, an outcome, a symptom.
Nevertheless, he is obviously a man of iron whim.
NHSE, I’m sure, were delighted to oblige him with pages of data. A welcome distraction from the day job… trying to run a whole system.
Ambulance performance might be one of several canaries-in-the-mine, but it’s a distraction. Being sidelined into believing it is a solution to the major issue the NHS faces, shows a lack of insight.
Management gurus, Kaplan and Simon tell us about the ‘Aha’ moment;
‘… having spent time attempting the problem, individuals reach a point of impasse from which they are unable to move forward… because of the continued application of mistaken assumptions about the nature of the problem.’
That’s where No22 got stuck and talked about more ambulances and targets. A cul-de-sac.
K&S continue;
‘… the insight into the solution [sometimes] emerges suddenly - giving rise to a so-called ‘Aha!’ Experience… rather than arising as a result of incremental processes…’
No22 is yet to arrive at the ‘Aha’ moment because he lacks insight into what the problem really is.
He’s stuck because he ‘sees’ a queue of ambulances and it becomes subject to ‘verbal overshadowing’...
... all the talk is about the pictures. How terrible it is. Embarrassing front pages for HMG. A visual manifestation of a deep seated problem. We are seduced into thinking what we see is the problem.
It is ‘a’ problem but not ‘the’ problem.
No22 became strongly motivated by information (about variation) that is unrelated to the solution.
Tunnel vision…
… it’s not uncommon. Lots of problems get the wrong solution because managers don’t ‘get’ the problem.
The NHS is a whole system. Problems are indicators of system problems.
Think of the NHS as a production line. Poorly people go in at one end and fixed-up people come out the other. Any interruption of the ‘line’ creates back-ups.
The classic approach to this type of problem solving is root-cause analysis.
Students of Six Sigma methodology, know it as a key component of their analysis phase. They have an acronym. DMAIC; define, measure, analyse, improve, control.
It’s sound… but clunky. Takes too long. In my view, too academic. There’s a quicker, sleeves-rolled-up, practical way.
The Five Why’s…
… ask the question ‘why’ five times and you’ll pretty certainly arrive at the root-cause.
Let's give it a try;
'We’ve got no ambulances to respond to 999 calls. They’re all queued up out side A&E.'
1. Why?
They can’t hand-over patients.
2. Why?
A&E is chockablock
3. Why?
A&E can’t move patients onto a ward.
4. Why?
Wards are chockablock
5. Why?
Because social care don’t have enough money and enough people to organise discharge care-packages, to get people home safely.
There’s yer problem... not ambulances.
Forget what they say, HMG have not sorted care-staff pay. It would mean going from £9.20 an hour, to about £14 or £15.
That is why No22 would rather fiddle about with ambulances, than tackle the real problem…
>> I'm hearing - the number of nurses and other health workers removing themselves from the NHS pension scheme has more than doubled in the past year... that has to be the impact of the cost of living.
>> I'm hearing - some nurses are being “actively" discouraged from voting for strike action by their managers. There's been “proactive" spreading of anti-strike information by word of mouth and through leaflets. Anyone got a copy of a leaflet I can publish, please?
