One of the most common statements in business is this:
What gets measured gets done.
The theory being that if you can deduce a method of measurement, a system of metrics, you have a way to quantify a process and thereby gain visibility of the variation. If you can see it, you can understand how those variables can be changed to both affect and effect performance.
But there are dangers when a process is reduced to a set of key metrics.
It is commonly known as “managing to the numbers”.
This is a narrow, mechanical, robotic approach to management where the only thing that matters is the attainment of the targets – how you get there, what you do, and how you treat people on the way doesn’t matter, only the successful attainment of the number matters. I’ve worked for managers like this in the past and it is not a fun experience.
10 years ago I worked for a boss who managed month to month and quarter to quarter and his only focus was the tactical execution so we could finish the month or quarter on plan. He had absolutely no strategic vision because he just cared about the immediate rewards and his bonus, not the longevity of the business – if it weren’t for a small group of senior managers who were focused on long term results, this manager would have destroyed the business.
When we have debated the potentials of Obamacare, we have focused on only two groups – who pays and who benefits – but we leave out one very important group, the people in the middle who must live and work within a system driven by these government imposed conditions. These are the nurses, the administrators, the doctors and the health care staff that will live this law day in and day out.
As a predictor, using the UK is certainly legitimate. There has just recently been a report about the health system local to my local area of Edinburgh, NHS Lothian, that doesn’t paint a very pretty picture of what these folks have been enduring:
A LONG-term culture of bullying, secrecy and cover-up led to NHS Lothian health board rigging its waiting time figures, according to a damning report by independent consultants.
The report by David J Bowles and Associates reveals a “blame culture” where the board’s anti-bullying policy has been breached; where bad news is buried and a “gloss” put on reports; and where staff are told “just fix it” with no questions asked.
It said the management styles described by staff, and a number of alleged incidents highlighted during interviews and focus groups, could be described as “creating an undermining, intimidating, demeaning, threatening and hostile working environment for some staff”.
This culture has “lasted for some time” with some middle management following their bosses’ lead on bullying – “emulating inappropriate management styles” – and with staff afraid to use whistleblowing procedures because of concerns about reprisals.
Last month, shortly after Health Secretary Nicola Sturgeon announced the independent report, NHS Lothian’s chief executive Professor James Barbour, 59, announced he was stepping down from his £195,000 post with immediate effect.
The health board’s crisis came to a head when it was caught manipulating its statistics by making last-minute offers of treatment in England to patients, in order to hit targets.
An initial investigation by PricewaterhouseCoopers spoke of a culture which involved the suppression of information and an “oppressive management style” – prompting demands for a fuller investigation.
“A long-term culture of bullying, secrecy and cover-up”…sounds like fun doesn’t it? A great work environment.
There are two types of careers; there are “craftsmanship” careers that rely on individual skills and individual talent and there are “execution” careers that rely on the pursuit of technical or operational precision. The former tend to be far more personal in nature – nurses, doctors, artists, lawyers and teachers – people who perform services where one to one relationships are important. The latter tend to be less directly personal and more organizational – technicians, engineers, industrial managers, corporate managers – people who are less directly involved in one to one situations and more concerned with non-people related processes or management of groups.
The use of metric driven management works well in the latter, I’m not sure that it does in the former. Where processes are rational and can be predicted and controlled, individuals are more random and less predictable, we are people – individuals after all. It is difficult to measure the quality of care based on the individual attention and concern of a teacher, nurse or doctor. How do you measure kindness, caring or empathy?
You can sure quantify the absence of it.
Socialized systems like those imposed by Obamacare in America and the NHS in the UK drive the focus away from the individual to the organizational, they focus on process – not the product. They replace the importance of craftsmanship with a focus on execution – attaining the numbers. They also reduce the ability for the patient to vote with their feet. In a market economy, if you don’t think your doctor is attentive enough, you can simply go to another doctor. In the UK, I am assigned a GP based on where I live and how many patients the other GPs have and that’s it. I can request another one but it is an involved process to do so and it has to be one within the designated surgery (what we call a practice) that I am assigned to.
This has the same effect as a commonplace event with regard to our educational system, that being of standardized testing. There is a concept called “teaching to the test” whereby school systems can generate high test scores and still not be truly educating the students. I know it happens with the FCAT in Florida, this isn’t just me talking, I’ve been married to a teacher for 31 years she knows.
That’s what NHS Lothian was doing.
Do we really want this for our health care system in the US?
Welcome to the future of healthcare in America. The only winners in this whole ordeal are the politicians.