Bruce Holland’s Strategic Snippet
Is the Public Sector is going in the wrong direction? February, 2011
The purpose of this Snippet is to illustrate how bureaucracy and red tape may be driving the Public Service in the wrong direction. Indeed, because of unquestioned assumptions, government may be inadvertently designing failure into many things they do on our behalf.
This bureaucracy and red tape is largely caused by deep assumptions of command and control and mechanical thinking that have come out of the factory model, straight from Henry Ford.
These assumptions are justified in the name of “efficiencies” and “economies of scale,” but delivering services are different from manufacturing products, and it needs different assumptions.
In manufacturing we want to minimise variation so the various parts can fit together within tiny tolerances. In services we want to build in variation because each person is different and so are their needs.
Service that ‘fits like a glove’ is a good definition for the delivery of services; and because every hand is different it needs a different glove!
An example of what’s wrong
Recently I was exposed to the health services in Wellington. It turned out to be a perfect example of factory thinking, red tape and bureaucracy. My daughter had just come home from having her second baby when complications arose requiring her to return to hospital with severe stomach pains. For five days she remained in hospital being passed from pillar to post as various experts came and went, without introducing themselves or saying why they were there, and often giving conflicting advice. It was almost as though the patient did not exist. The nurses did their best but were subject to a system controlled by doctors who hardly talked or listened to my daughter. Throughout this whole time she remained in severe pain. It was a classic vicious cycle. Because of her pain she couldn’t sleep which made her worry more; as a result her milk production reduced and her baby lost weight, this made her worry more and sleep even less.After I had witnessed doctors coming and going for the third time, I stopped the important looking expert who had just swung in to my daughter’s cubicle with at least four interns in attendance, and demanded that he introduce himself, explain in lay terms what was wrong and why he was prescribing medicine, the previous doctor had said she shouldn’t take. He was totally taken back with my insolence, especially in front of his underlings, however, unlike my daughter who was uncharacteristically vulnerable in her position of helplessness, I stood my ground and at last he explained what the problem was.
When I talked to the nurses, I found that this was just the way the system works. There is no case ownership. No one is in charge of a patient. There is no way of gathering the experts together to pool their knowledge and expertise in front of the patient so that everyone, including the patient, agrees and understands the treatment to be delivered.
I’m sure the hospital met its activity targets because the required rounds were made and no doubt the appropriate forms were filled out, however the real measure of the patient’s needs in terms of the time it took, end to end, to return to physical health was woeful; and the time to return to psychological health was even longer.
A much bigger problem
I think my daughter’s experience was a small example of a far bigger problem in the public sector. It’s all associated with factory thinking and assumptions of economies of scale. When you stop seeing it like a factory and more like a living system (think like a gardener) it becomes obvious that each Agency needs to be part of the customer’s solution and work together to deliver it. As long as they work in silos of separateness, fail to work together and have no one who is accountable overall, the customer’s problem will persist. Just think about a young person in trouble. Child, Youth and Family need to own and manage the relationships with Police, Education and Health, otherwise the child will be passed from pillar to post like my daughter.We need to regularly gather the experts together to pool their knowledge and expertise in front of the customer so that everyone, including the customer, understands and agrees the solution to be delivered. If they did this the time it took, end to end, to achieve the physical, mental, emotional and spiritual health of the customer would be far less.
When you are alert to it, you see factory thinking all over the public service. I’ve already touched on the health system, now think about the way our schools are organised to produce products that are all the same, know the same curriculum, pass the same standards, sit through siloed subjects, taught by teachers in specialist subjects, all set from top-down, by a remote central Ministry of Education. Similar patterns apply in social welfare, aged care and many others.
The current drive by government departments to share back-office functions is part of the same thinking. It is designed to save costs but will in practice lead to inefficiency and increased costs. Moving functions to a central location seems to make sense except that it also removes the delivery of the service away from the people who need the service. This creates problems with handovers, rework and duplication. More people in the process means every time a file is opened it has to be read. More reading increases the risk that it might not be read carefully enough to be understood. The more work is sorted, batched, handed over and queued, the more errors creep in. Customers of the service find it difficult to access the person or service they want and before long they duplicate the service by going outside to source it from somewhere else.
Economies of scale lead to practices like call centres, back offices, outsourcing, shared services, Super Cities, but none of these make sense in service organisations.
other links..
The Business Case for Collaboration
Definition of Collaboration
Bruce Holland
Virtual Group Business Consultants
PO Box 6521, Wellington, New Zealand.
Ph. +644 5700727
www.virtual.co.nz
Liberating the human spirit at work