Inspection: making it up as you go along

 

A systems thinker who attended a meeting with the Commission for Social Care Inspectorate (CSCI) writes:

“In determining adult social care star ratings, inspectors said they would look for ISO9000, IiP, Charter Mark or some other external accreditation. The CSCI took the view that these standards would indicate good performance management. The message was clear: if you don’t have these standards you will not get top ratings.”

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A horrid idea, as he knows. But you can see how someone who knows no better could come up with it. It is depressing to think of the waste this will cause and not only in performance terms, morale will suffer too. How does this happen? Someone in authority has told the inspectors these things can be assumed to be of value. If only they knew.

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The reader also told me the minister has told inspectors to develop outcome measures. Apparently the first the inspectors dreamed up is something they think is a test of whether service users are treated with dignity: ‘the availability of single rooms in residential care’.

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A brave person attending this meeting dared to suggest you can have all the accreditation in the world but it doesn’t mean or imply you have a good service and that to ‘measure’ what the outcomes are for service users, CSCI would have to go to where the work is done as you need to understand what the demand is and whether it is met based on what’s important to the service user, which might be different for each person. Obviously a systems thinker.

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Apparently the inspectors’ responses were blank looks on the accreditation issue, and ‘But the Minister has asked for outcome measures that can apply to all councils’ on the other.

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So that’s all right then. But these people make it up as they go along. In doing so they inflict massive waste on these organisations. They ought to be concerned with ‘how do we know what works’? The minister should be held responsible.

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Systems thinker meets his inspector

 

A client who has made great use of systems thinking in the public sector writes:

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“We have just survived (I think) inspection by the Audit Commission. Verbal feedback has been positive, although I won’t know for sure until we get the written report. We made a deliberate choice to go into the inspection with no targets, no measurable service standards, no appraisals, and not much of a formal performance management system. I have to say that although the inspectors were perfectly friendly, it was an incredibly stressful experience and a big diversion of time and resources. They clearly struggled with understanding an outside in approach rather than a command and control one, even though they liked what they saw. I think they had an open mind, but it is so difficult to lose the conceptual framework in which they are working. I think they really want to put us in a box called ‘weird’, and for the time being I am happy with that, as we took a bit of a risk.”

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Command and control thinkers do find it weird. It is because their normal forms of ‘control’ are not evident. Of course they are not evident because these people have learned they are not actually controls, they are instead causes of waste.

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I wrote back to commiserate and support, pointing out the strength of their position was that they could show they had understood and improved the work. It also helped that in the light of the perennial debate about the failure of the specification and inspection regime, the inspectors are being told by their bosses ‘what matters is what works’.

 

He replied:

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“The inspectors said to me that they could see that things were changing all the time, in fact one said the staff were making changes while they were in the focus groups with the inspectors, but they could not really understand ‘how’ as they could not see improvement plans and milestones etc, all they could see was change happening. The lead inspector said that he could see this was ok for ordinary change, but how could we do complex change; rather tongue in cheek I said ‘why would we want to make change complex?’

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The inspector could not see that thinking his way, he would have made this change complex. I am constantly amazed how simple public services have been made hugely complex by government-inspired interventions.

The heart of the problem in this meeting is no different from when planeloads of businessmen visited Japan in the ‘70s to find out how they ‘did it’. They copied the things they could see (hence quality circles etc) but could not see what they needed to see, a different way of thinking about the design and management of work. What disturbed the mind of the inspector was trying to put what he could see – people using their ingenuity to improve the work – into his current view of the world. I bet he found it stressful too.

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If things look bad, change the measures

 

Apparently the Department of Health is consulting on new ways to measure NHS productivity. Why? Because the recent Office of National Statistics report said productivity fell by between 0.6 and 1.3% a year from ’95 to ’04. As ministers have doubled spending this doesn’t look too good.

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Ideas being put forward include measuring waiting times and the patient experience. To measure waiting times as a proxy for productivity is, simply, the wrong thing to do. I would have thought DoH people would by now have woken up to the distortions created by this and other arbitrary measures.

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Have we any confidence these people know what they are doing? Their first step should be to understand the ‘what and why’ of health service performance as a system. They would discover the current measures are part of the problem and not the solution; in doing this work they would have been obliged to implement system measures and would thus have a good idea about the capacity and waste in the system. Then they could return with some confidence to solving their current problem.

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But I guess the current problem is political. So we should expect them to try anything that might support the view that things are improving. And by the way, I have just heard from my people working on our first NHS assignment. It looks as though the government targets on being seen have focussed resources on the front end, creating a backlog at the treatment end – yes the thing the ‘customer’ wants. And, as I said in my book, we find no measures of demand and outcome, if the NHS isn’t there to deal with that, what is it doing? Watch this space.

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Things look bad because they are bad. Ministers should be held responsible. What is the purpose of this system, what have the ministers made it?

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Cranking up executive power?

 

Wrapped up in an attractive-sounding Regulatory Reform Bill is the power for ministers to add to regulation and legislation without the need to debate the measures in parliament. It could mean open season for ministers who are frustrated by the lack of change for the better in our public services. I think we should worry. I think we should impress upon them the need to switch their funding from promulgating bad management to finding out what works.

 

If you don’t make the target…

 

Hold your breath, this is really boringly detailed… you can cut to the end if you want.

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In March 1999 the government set a target for the educational attainment of 19-year-olds. By 2002, 85% of them were to have at least a Level 2 qualification – the equivalent of five good GCSEs. In 1999 attainment was just under 75%.

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By 2000 nothing had changed. 2001 and 2002 showed no change (75.3% and 74.8%). However, during this time the 1999 targets were replaced by public service agreements. These set a ‘new’ target: the proportion of 19-year-olds attaining at least a Level 2 qualification was to rise by three percentage points by 2004. In other words, it should get to 78%. Clearly less than 85%.

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In 2003 it got to 76%. In 2004 it was 74.4%. No doubt unaware of the madness of doing so, another target was set in 2004: This time to increase by three percentage points between 2004 and 2006, and a further two percentage points between 2006 and 2008.

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At the same time it was announced that the figures would be counted in a new way. Apparently the old way of measuring things, using data from the annual Labour Force Survey, was flawed. It relied on data provided by parents. The new method is to collect data directly from examination boards or educational institutions.

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The first result under the new method (2005) showed 69.8% of people aged 19 were qualified to at least level 2. Oh golly, things are worse than they seemed. This caused a revision of the ‘baseline’ data on the grounds of improved reliability; the consequence is the minister can now say he met a target. You can work out which, I am losing the will to live.

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I am more concerned about the recent report that said University Lecturers were finding school leavers to be unable to think in basic academic ways. It gives credence to the view that our schools are teaching children to pass tests, not value learning and thus learning how to learn. Taking the value out of education can only have terrible consequences. If you hear your children asking: “is it in the exam?” worry.

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A view from the front

 

A school governor writes:

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“I’m a primary school governor and am very uneasy with many aspects of the new Self Evaluation scheme. The amount of paperwork this small school of 5 teachers has to wade through is simply astonishing. Most of the curriculum policy documents I have assisted with recently are simple copy and paste jobs from best practice websites. I wonder what value they are.”

 

Of course the purpose of the paperwork is to give the inspectors something to inspect. No different to the starting place for the first of the British inspection diseases, ISO 9000. And forgive me if I remind you: as ISO 9000 registrations diminish in the UK, France and Germany (we now know it is a pile of pants), the growth in the ‘new economies’ (Russia, Rumania, China et al) is phenomenal. The best British export ever, but at least it is nobbling the opposition. And who do you suppose is telling these people they have to have ISO 9000 to trade in the new global economy? Answers on a post card please…

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Fresh thinking about schooling

 

I had the good fortune to meet Maurice Holt a life-long educationalist who leads what he calls the ‘slow education’ movement. Like fast food, education has become standardized junk. You can read a paper by Maurice on the Vanguard web site, go to https://www.vanguard-method.com/v1_lib.php?current=926

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I am pleased to say Maurice Holt has agreed to speak at the Vanguard event in October this year…

 

The Toyota System for service organisations: a Vanguard Event

 

On October 17th and 18th we will be running an event (The Toyota System for service organisations) that shows the depth and breadth of Vanguard’s work. The event will feature practitioners from financial services, utilities, housing, local authorities, police services, HR services and more. The practitioners will tell you what they did, what issues they faced and, most importantly, what outstanding results they achieved using the Vanguard Method.

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On top of that we will feature core content from the Vanguard Curriculum for those who want to get down into the detail. There will be plenty to choose from to suit all interests, and some surprises. The event will be held at the delightful Heythrop Park in Oxfordshire.

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We are not taking bookings yet, but if you want to register your interest please contact Polly: office@vanguardconsult.co.uk 01280-822255.

 

Lean Fundamentals

 

On 23rd May I shall be presenting an overview of Lean Fundamentals. It is the programme we recommend as a starting-place. In effect, it is a self-scoping programme; participants get to see for themselves the benefits that could be achieved by ‘going lean’ in their own organisation.

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The presentation will cover: A brief history of lean (what really happened in Japanese manufacturing), how service is different to manufacturing (and this why the manufacturing tools are the wrong thing to do), lean principles for service design: how they improve service, reduce costs and improve morale; and the structure of the Lean Fundamentals programme: who should attend, what happens and how it works.

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The cost is £50 + VAT to cover the day-delegate rate. To book your place, contact Polly: office@vanguardconsult.co.uk, 01280-822255.

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OK, OK, I am a professor

 

The Lean Enterprise Research Centre, Cardiff University, has honoured me with a visiting professorship. OK, I know many people will be amused. It tickles me too. We (in Vanguard) will be making a significant contribution to their new MSc in Lean Service. I am pleased to be able to introduce students to our work and I look forward to stimulating research and academic writing on this work.