The BBC news story on 28^th July 2011, about Whitehall being ripped off by large I.T. firms made interesting reading. (Click Link)

Yet again, Government is wondering how they are spending so much money on projects that deliver very little, or in some cases nothing at all.

There is little doubt that the I.T. firms are making money out of Whitehall, but I do question whether it is wilfully ‘ripping them off.’

One of the key factors in the many examples available of I.T. contracts and projects that have gone so array, is the lack of understanding by Senior Managers in the Government on how to negotiate workable contracts, manage projects and set realistic budgets.

Change is all about us. Today it is not possible to switch on the radio or TV without hearing about “radical change”. The Public Sector in particular is going through it right now. Although I have to say that when I took up my first Civil Service post 20 years ago we were apparently going through major change and over the years we are always in the throes of one change programme or another, I lived through many a programme where things didn’t feel that different in the end.

When I think about change, I am still surprised at the lack of willingness to challenge “givens”. Every system or way of working has them.  Over extended periods of time they have been features of systems, usually for very good reason, they were in the past critical to making the system work but as time has passed even though no longer critical to anything, they are there, custom and practice, an untouchable “given”.

The criticism in the news around targets in the NHS is given fresh impetus today with the story about A&E targets and it’s effect on patient safety. 

BBC NEWS

Once again, the public sector, seem to have tied themselves in knots with more measures that are clearly driving the wrong behaviour. Cut through the variously spun political messages and you get down to the core issue that tick box targets don’t add value to an organisation.

Unfortunately in this case, it’s people’s lives that are being used as the gaming pieces of this argument.

The Chairman of the College of Emergency Medicine, Dr John Heyworth is on record saying that he has nurses in tears and Senior Consultants threatened with disciplinary action over this target.

In his words “This is an outrageous misuse of the standard” is a perfect summation of all that is wrong with target driven behaviour.

The staff placed under immense pressure to meet these targets find themselves bending the rules to massage the figures. When you are producing “Widgets” this can be put down to sharp practice, but when it’s people and their care it’s criminal.

Now these targets were all conceived with good intentions in mind. They were always meant to be about improved service, reduced cost, greater efficiency and improved patient care. However they were looked at far too simplistically. An holistic systems thinking approach to patient care in the UK would have produced a very different look to the NHS. I’m sure that targets would still have been the outcome, but maybe these targets would all be complementary to each other.

The pressure to dispatch people from A&E within 4 hours has knock on effects throughout the whole of the NHS. You may show improvement in this one area, but what does that improvement cost the rest of the organisation?

If by rushing people through one department you end up with people who are inadequately assessed, then the whole treatment regime they may be heading for could be incorrect. This will cause increased cost, resource drain, inefficiency, not to mention the fact that this sick human being is not being cared for. Isn’t this the core job of the NHS, care?

Of course the worst case scenario is people dying. There we have different knock on effects. Reputation damage (Look at Stafford NHS trust), public trust shattered, increased checking by inspection bodies, lack of staff motivation and engagement, all leading to organisational paralysis.

It is not just the NHS that is plagued by these methods of performance analysis. The whole of the public sector is beset by targets that drive the wrong behaviour. The frightening aspect is that the pressure to achieve, backed up by a Command & Control approach from the top to ensure they achieve forces people to shelve their principles and better judgement and cheat.

Who would have thought that a tick in the wrong box could cost a life, but it could. If you were able to confront that member of staff with that reality, how do you think they would feel?

When will our public bodies listen to the constant stream of advice from people like John Seddon and apply a “Systems Thinking” approach to our public services.

We’re quite literally dying for it to happen.

Matthew Scott, Dip. Management, Cert. MCE.

The views expressed in this article are solely those of the author and do not necessarily represent the views of the IBC.

I have been appalled by the coverage over the past few weeks regarding death of Mr. David Gray in February 2008, and the role played in his death by Dr Daniel Ubani, a German national.

I am sad of course for the bereaved family, nothing can mend the sorrow they feel for the loss of their father. The case is dealt with in detailed coverage, read more at:

BBC News

Now as we learn the lessons, try to put in place improvements and better risk management to prevent a tragedy like this from happening in these circumstances again, I am astonished that the focus of much of the media coverage has been on Dr Ubani’s language skills, or lack of them. Surely the obvious question here is not whether the Doctor’s English was sufficient, but the fact that for the on-call out of hours service, a Doctor needed to be provided from Germany at all. Where on earth was the local GP on-call service?

After a protracted period of negotiations, in June 2003 GPs voted throughout the UK to accept a new contract for the delivery of general medical services. It is described by the Department of Health as “a landmark in the development of general practice”. The new contract brought with it a significant investment in salaries of 33% over three years.

Whilst that investment paid for harmonisation in GP terms and conditions across the UK (never cheap) the deal also gave GP’s the right to opt out of the out of hours / on call service provision. Identified as an “issue” at the time, that issue has clearly not been adequately addressed.

Surely this is a simple case of a system not thought through, of driving the wrong behavior in people by setting up inadequate, incomplete systems and processes? The negotiations are described as “protracted”, I’ve been involved in those kind too, it was probably very difficult, painful even, and there will have been times when both sides thought they’d never get a deal. Is the horrible truth that someone, not thinking in a systems way, desperate to get a deal, didn’t think through the lasting effects of not adequately addressing service provision for the other 13.5 hours of the day when we are outside of what is classed as “normal working hours”. The standard working day may well be over, but healthcare is a 24 hour business.

Did the negotiators, in their desperation, when a deal seemed so near and yet so far away, settle, thinking that they would come back to the sticky issue of out of hours/on-call later, but never quite get there, missing out on a fantastic opportunity to design the system to flow towards the needs of the user, to align the working practice, policies and procedures so that it all made sense?

A quick perusal through news reports over the past few weeks shows that there is a high degree of industrial unrest at the moment, employment relations is front page news. Damage to the customer is often cited as one of the critical reasons that both sides just keep going back to the table, not leaving until the dispute is resolved as they recognise that without their customers, eventually they will have no business left to argue about.

I wonder if thinking in a systems way, placing the user or customer at the heart of its design, those protracted negotiations would have delivered a rather different result. Surely it is worth going back to the table now, to re-design what has been exposed as a completely inadequate system for the peace of mind of all the relatives whose loved ones death were ruled as avoidable. And for the rest of us too, for whom there is a high possibility that when we fall ill, it won’t conveniently be during daytime working hours.

When the stakes are so high, we should be prepared to hammer out the right deal for everyone, no matter how protracted.

Jane Pound MIIA

The views expressed in this article are solely those of the author and do not necessarily represent the views of the IBC.