Sir David Nicholson

Yesterday two NHS nurses were struck off the UK nursing register for bringing their profession into serious disrepute.  One of the features of this case was the falsifying of records so that ‘performance targets’ could be met. 

The NHS has been trying to copy ‘lean’ for some years (as has every manufacturing business in the world) but it has always been very obvious, to anyone who has read Deming’s work, that the culture has to be right first. The architects of the NHS have created a performance metrics monster that will have Deming, the guru’s guru of total quality management, turning in his grave.  The fate of these two nurses is symptomatic of everything that is wrong, not only in the NHS, but the whole area of performance measurement and management.

Deming’s ’14 Principles’  include, at number 10: –

“Eliminate slogans, exhortations and targets for the workforce asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the workforce.”

These nurses are part of the NHS management ‘system’.  The inverted commas signify that there is no management system in the NHS. An effective system would already be delivering the organization’s purpose – the best patient care at the best possible cost – that is the definition of value.  The NHS’s perverted ‘performance management system’, based on meaningless targets, produces perverse incentives and perverse behaviour.  Whether these two nurses are guilty or not, it is unlikely they became qualified nurses to fiddle figures.  So what did the NHS do to them?  If the NHS cannot care for its own staff (all 1.3 million of them) it is unlikely to be able to provide the best care for its patients.

The managers at the top of the NHS must take responsibility for the system they design: therefore they must be the root cause of catastrophes such as Mid Staffs. The other group primarily responsible are all the former politicians (now long gone) who became Health Secretaries and made the NHS a political football rather than a beacon of excellence. Neither executives nor politicians can be struck off (even when found guilty) because they do not belong to a recognized professional body where Deming’s teaching is mandatory.  Another group who have played their own part in this on-going fiasco are the HR professionals who should know better but recent, high profile, experiences suggest otherwise.

MI is the professional body that really understands how whole systems work, at a very profound level, and how intelligent use of value measures can bring out the best values in people. MI is dedicated to developing the next generation of executives and general managers, and HR professionals, who will have to become consummate people managers. Professional managers will have Deming’s 14 Principles tattooed on their foreheads; just so ordinary employees will know who to turn to when they are feeling pressurized to do things they would not naturally choose to do.

Postscript – Nurses ‘ration care due to time pressures’


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