Monday, 6 January 2014

Waking the NHS from enchanted sleep

I make no apology for returning to Roy Lilley’s NHS Managers blog, partly because it is probably the most expert influential public services blog we have, and partly because meeting Roy a year ago inspired me to take up blogging rather more often than once a month.

I don't always agree with him, but he has that absolutely vital ingredient that seems to be lacking from so many other experts in public services: humanity and common sense.

I’ve only written two posts this year and both have been about much the same idea and this is too. It is how to inject humanity back into the public service systems that were conceived by McKinsey, shaped by the service management gods of the Blair years, and implemented by the Brown regime (and not yet tackled fully by the coalition either)..

It was the contention  of my book The Human Element that services had become less effective, and therefore more expensive, because that humanity had been systematically excised in search of the old failed Taylorist notion of the ‘One Best Way’.

So I thought that Lilley's injunction today deserved repeating:

"Bad managers copy bad managers. Beware of any who only use sports, or military metaphors. Talk the language of friendship and family. Recognise the NHS employs more women than men and most patients, carers, residents and friends will be women. Is your place women friendly? How many senior managers and Board members are women?"

Management language of the kind his is talking about is invented by consultants, who need to give the impression of new wisdom and new ideas. Often they jargon takes the place of new ideas. Often there is no diernable idea at all behind it.

But the critical part of what Lilley says is that the language of family is what is required.

Clearly there are pitfalls here, and the most inhumane bureaucratic systems just get re-badged with friendly family-sounding language. The point he is making is that the NHS needs to give less respect to the jargon of management consultants, and more respect to those who use clear language which says unambiguously that the objective is love and care - not dehumanising people to make them easier to process.

If managers can do that, they may be able to see more clearly when their systems provide something else instead – even when they go haywire and start starving patients to death in pursuit of target figures.

This story has all the elements of fairy tale, maybe like Sleeping Beauty. Service managers have been enchanted by the jargon of the management elite. It puts them under a spell and makes it hard for them to see clearly what they are doing.

That is why actually the common sense of language of humanity can frighten the hierarchies. It is scary because it threatens to release staff from the spell, which may render them – horror – inefficient.

In fact, as I have argued elsewhere, their human skills are very much more effective at creating change, once and for all, in other people - and much more than their IT and systems skills.  Losing the veneer of efficiency will paradoxically make them more effective, and therefore reduce the cost of the service.

So there is a new year’s injunction for all of us. Shun the language of assembly lines, and the latest fads of the consultants, and tell it very clearly how it is.  That's how we wake from our enchanted speech.


BruceK said...

Is there any evidence for this?

As you note, family metaphors can as easily be abused as any others. In fact, if anything more so. The consultant is spared the arduous necessity of googling 'Napoleon' and can rely on anecdotes, quite possibly invented, about his children and his dog, also possibly invented.

But equally, I think military history contains some very useful lessons for managers, if mainly of the negative variety. Going by the Amazon reviews of 'On the Psychology of Military Incompetence' that is quite a widely held view, and so I don't see that avoiding military metaphors would do any particular good.

David Boyle said...

Bruce, you may be right about this. I certainly don't object to military metaphors compared to vacuous management-speak. I do draw the line on sporting metaphors though...

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