Tuesday 29 October 2013

Deming, CQC and the new efficiency

Back in the 1940s, the great American theorist of 'total quality, W. Edwards
Deming warned that assembly lines, in themselves, were not efficient at all. We ought to listen to that, given that our public services are being re-designed by people who think that assembly lines are the apotheosis of efficiency.

Deming’s story is rather peculiar, because he found that his fellow Americans were not quite ready for this message, so he took his ideas to Japan after the Second World War, and was enormously influential.

Efficiency is all about getting things right first time, he said, because then you don’t have to do it again.

He was astonished at how much the American factory system wasted, in materials and time, just by failing to pay attention to quality. The result was the enormous sums of money were spent by organisations just to put right the mistakes they had made – and splitting up jobs means more mistakes.

Now Deming’s name is being gargled with at the moment by the influential NHS blogger Roy Lilley, as a way to explain how ineffective the CQC has been – in fact, about the whole business of inspection and how it has failed miserably to make hospitals safer.

It just so happens that I went to a fascinating conference yesterday, organised by Deming’s vicar on earth, the systems thinker John Seddon.

Seddon himself was stuck on a train thanks to the storm, but I did have the chance to hear from four amazing women from Monmouthshire County Council who are in the process of transforming social care assessments.

So much so that they seem to have provided a kind of template for the new flexible assessment system that the Welsh government are introducing in January.

Monmouthshire has developed a fascinating combination of systems thinking, Australian local area co-ordination. They call the result FISH (find individual solutions here).

It is about getting interventions right first time, the very essence of what Deming suggested.

What really excited me is the way they have turned the conventional call centre model on its head. No more phoning a call centre that will record details and hand over them over to back office experts, who will then set appointments and so on and so on, all before anything much happens.

Now people call up and speak direct to an expert, who can if at all possible sort things out there and then.

Some cases will need more complex assessments and work, but – by sorting out problems early and informally where possible – they have reduced the number of these by half.

There is a great deal more to say about all of this (which I won’t) but it does drive a coach and horses through the conventional, and evidence-free, government preference for shared back office services.

Seddon has been a lone voice describing how the front office/back office division has been increasing a sort of fake demand, at great expense. But there are two problems at the moment that have been bothering me.

First, how do you persuade Westminster and Whitehall that the whole caboodle of IT systems, back office divisions, and outcome-based management is actually undermining the effectiveness of services and making them more expensive?

Second, how do innovators like Monmouthshire confront the useless requirements of the existing regulatory system? Neither there, nor anywhere else, has the battle been won. In fact, it has hardly been joined yet.

Third, why on earth is Seddon describing his seminar roadshow as ‘Kittens are evil’?  I know what it means of course, but it seems to imply a modesty and self-deprecation that his ideas don’t deserve.

Too many negatives, I say. We need kittens.  Welcome to the new kittens, I say.

1 comment:

Stuart said...

Anywhere I can find more info on the changes in Monmouthshire? Have had a search but not finding out. Cheers!