Category Archives: Service

Lessons from Florence Nightingale 200 years on…

Contribution by Kent alumna Dr Rachel Black     (SSPSSR 2011)
Chief Executive at the Orpheus Centre

12 May 2020 marks 200 years since the birth of Florence Nightingale, pioneering nurse, researcher and social reformer.

 

Florence Nightingale combined phenomenal caring skills with brilliant intelligence. She was a fan of data and used it to change practices and improve people’s health outcomes. During the Crimean War, many more men died of infection than of war wounds. Florence Nightingale radically reduced mortality rates by delivering outstanding infection control and nursing care to those people.

The Covid 19 pandemic is also being managed in large part through rigorous infection prevention and control to prevent people needing to be hospitalised. People are washing their hands frequently, staying at home, practicing social distancing, and self-isolating if required. We have all radically changed our lives to accommodate such changes.

I have been a nurse for my whole adult life, starting my training when I was just 18 years old. In some ways my role as CEO at Orpheus has felt like the furthest move from clinical practice I have ever made. Not anymore! With Covid 19, I am absorbed in physical and mental health risk assessments, designing and implementing practices to control and prevent infection, reviewing presentation of symptoms and deciding on courses of action. All of my accumulated nursing knowledge and skills are being utilised.

I hold the following words of Florence Nightingale in esteem:

Let whoever is in charge keep this simple question in her head:
not, how can I always do this right thing myself, but how can I provide for this right thing to be always done?

(Florence Nightingale, Notes on Nursing: What It Is, and What It Is Not).

In keeping our services running, I am always aiming for the Orpheus Centre and all our workforce, volunteer and paid, to do the right thing: to keep our students safe and well above all, to maintain their care, to promote their independence, and to keep them learning. I am of course prepared to step in anywhere, but I need to ensure the workforce and families have the resources and support to play their parts excellently. It is a tribute to our wonderful donors and funders that we continue to have those resources available and we are forever grateful.

The Domiciliary Care Team at Orpheus are not registered nurses, but they do nursing care. They develop supportive and trusting relationships, they enable students to feel confident when they are most vulnerable, and, in partnership with other professionals, they tend to the needs of students when they are at physical or mental low ebbs. Like many care services, the range and complexity of skills they are expected to practice is ever growing and increasingly complex, particularly at this time. Our Domiciliary Care Team is brilliant. In the world’s hour of need, it is the traditionally under-valued, customer-facing job roles which have kept people safe and even alive. During the Covid-19 lock-down we clap for carers on Thursdays and put up our rainbow posters. It should not have taken a pandemic to see how the world needs these people. We must not lose sight of their importance in the months and years to come.

Florence Nightingale also said:
Were there none who were discontented with what they have, the world would never reach anything better.

Faced with the unknown of a pandemic, all the Orpheus Centre students, parents, volunteers and staff have made tremendous changes to their personal and working lives to make the world better by keep themselves and each other safe. People have been amazingly flexible and good-natured in really trying circumstances. They find themselves undertaking tasks they do not usually do and, frankly, may prefer not to do. Above all, people have been hugely kind and so very patient.

Dr Rachel Black, CEO, the Orpheus Centre

I think Florence Nightingale would look on the Orpheus Centre with approval. She would see a large team of students, parents, volunteers and staff who are all working for the good of the students and each other. She would see a team of staff who are always empathising, prioritising the wellbeing of students and parents, looking out for each other’s needs, and, essentially, keeping the working space and their hands so very clean.

I am in awe of Florence, but I am also in awe of the Orpheus Family and so very proud to be in it.

 

Reading:

Nightingale, F. (1992). Notes on nursing: What it is, and what it is not. Lippincott Williams & Wilkins.

Orpheus (2020) About us https://www.orpheus.org.uk/about-us

 

Costs are found in flow – not within activities

 flow2To reduce costs, the expectation is that we must ‘gain efficiency’. This means speeding up the activities which we carry out or reducing the amount of money spent each time we do it. To understand the speed of activities, we should (surely!) count those activities or their cost – and perhaps see how quickly they are repeated or how much cost they accrue. Does this make sense so far?  If it does, then you have been led down the garden path.

Meaningful change should relate to the purpose of the team (essentially their focus on the work), and the team’s purpose should fit with the wider organisation’s purpose. Efficiency gains mean nothing if purpose is compromised. Even cost savings to save a business must be purposeful (and related to core business) if that business is to have any chance to succeed in the long term – otherwise it is just giving respite to an essentially lost cause.

Next consider whether your change is going to impact/intervene with the task (work), the team, or a particular individual (or individuals).

  • With task changes you are interested in both the value of the task (output quality as assessed by the user) and the flow of the activities (timeliness and waste/repetition/failure recovery etc).
  • With team you are looking at effectiveness of contribution and team energy, morale, sharing, learning, synergy and interactions.
  • With individuals it is about their contribution, development and commitment.

If people have been brought along with the change, the reasons, how it fits with team purpose and how it improves output for users at less effort for us (or at least, less wasted effort), then you are much more likely to avoid problems with ‘team’ and ‘individual’. So in a roundabout way a holistic view is important. But it is important at the outset  – during the design of your intended change (when you consider what /where/when) and how you design the ways in which  to get people on board in that design.

The reason people get bothered by change is either:

1) because they know the work and can see the pitfalls and would prefer to implement changes that would make a real difference (potential positive constructive contributors), or

2) they know the pitfalls and want to hide them because they should have raised those problems themselves, so feel a bit exposed (likely negative grumblers).

The ‘1’s will be in the majority – you need to make sure those people don’t become grumblers because their input has not been sought or valued!

 

Reading:

Adair, J. E. (1973). Action-centred leadership. McGraw-Hill.

Seddon, J. (2003). Freedom from Command and Control. Buckingham: Vanguard Press.

Targets only motivate people to meet the target (not to do good work)

The reasons for employing people are:

1) to do the work (produce output, product, service), and

2) to improve the work.

If the person is clear about the purpose of their work, then 1 and 2 should be easy to deliver if they have the right resources, skills, and understanding of users’ (e.g. customers) needs.

But managers rarely leave it at that…

Traditionally, managers get people to do ‘better’ in their work by what John Seddon tags as ‘sweating the labour’ – getting the people to work harder or faster. The idea is that you get more output for the same hours work – essentially more for the cost (efficiency).

Of course the idea of the sweatshop is morally uncomfortable – exploitation to achieve a profit motive. Yet we still stick to the idea by setting targets: ‘You produced 100 widgets last month, let’s have you aim for 110 widgets this month‘.

It seems plausible – motivational even! What possibly could be the harm in setting a target?

Well, the widgets are being created for a purpose – presumably the purpose for which the customer buys them. And that purpose is associated with the design and quality if production in the widget that is produced.

If you create arbitrary targets (and measures of performance) you will create a de facto purpose in people’s mind which is to deliver those targets. This is different from actually delivering the purpose of the work.

Your worker will work to produce 110 widgets BUT not necessarily a widget that meets the customer needs, nor a widget that could be produced faster or at lower cost whilst still meeting the customers needs, other than by cutting corners (lowering quality or increasing risk). The worker is busy but has got his eye off the ball. This produces errors and lowers the quality of work – which will probably have to be redone – at greater cost.

Targets are not motivational. They might make people move, but that is not motivation. A dog that moves is just one looking to avoid the next kick. It is not a motivated, free thinking, creative, proactive animal. Why would we exect people to operate any differently?

Reading

Herzberg, F. (1968) “One more time: how do you motivate employees?”, Harvard Business Review, vol. 46, iss. 1, pp. 53–62

Seddon, J. (2005) Freedom from Command and Control, Vanguard Press, Buckingham, UK.

You couldn’t make it up!

Picture the scene…a middle aged man digging in his garden, when he hits an object, possibly a root, which slows his spade. Lifting the top 3 inches of turf away, he clears the space to find that the object is an intact, unfired rifle cartridge – complete with bullet. He thinks ‘Hmmm – either an intact live cartridge or a replica, but 3 inches under my lawn‘ and decides to call the police non-emergency helpline to request its secure collection (the nearest police station is over 10 miles away).

The helpline service is reasonably helpful – it automatically patches the call to his county police constabulary and after a little wait he gets through to a real person. The operator is personable and thorough, takes note of the details (the middle-aged man used to be a marksman, so knows a bit about bullets and was able to convey this). The operator agrees to call back to arrange the collection.

About 5-10 minutes later the Police helpline operator calls back and informs the man that after consultation with her supervisor they have advised that the bullet is simply disposed of. The man suggests that he will not throw it in a fire or anything, but how should he dispose of it? He is told to put it in a bag and pop it in the dustbin.

The waste bin was collected by the council service that day…

The man, knowing a bit about ammunition, had already decided that he will not put the bullet in the waste and instead plans to find a way of getting it to the authorities – ‘waste worker shot in freak accident‘ is not a headline he wants to see in the Sunday newspapers.

Two minutes later the helpline call again: ‘sorry‘, says the operator ‘my supervisor and I have spoken to the inspector who suggests we get someone to collect this bullet from you. You haven’t thrown it away have you?

What is the point of this story? It is this:

However good your procedures and however willing and polite and committed your operators, a helpline service must have expertise at the point of transaction – the operator. If not, you tend to add re-work (e.g. lots of follow-up calls) or waste (or worse).

Sadly, most advice centres are NOT designed this way, instead using less-qualified people on the phones; creating waste, error & discouraging users.

In this instance neither the operator nor their supervisor had the expertise (or judgement) to make this decision. How did the discussion and advice arise between call 1 and 2? How did the second discussion with the inspector arise – was it luck, or part of the procedure of escalation? What would have happened if the inspector had not been there? What if the man HAD put the bullet in his dustbin? What if the man had gone shopping before the third call was made?

How many police would have been required to search the man’s bin, or worse, the contents of 5,000 bins at the council refuse centre had the bin been collected? Or what if all bin lorries had to be stopped on the roads for inspection to remove the suspect bullet? What if the bullet had exploded? You get the point.

This was a real incident involving real people on a Bank Holiday Monday sometime in the past year. You really couldn’t make it up.

 

Further reading on call centres:

Seddon, J. (2005) Freedom from Command and Control, Vanguard Press, Buckingham, UK.

 

The evolving and multifarious role of the administrative professional

These days, Higher Education clerical and administrative staff are expected to be equipped with multifarious skills and competences and the role of professional administrative staff is seen as pivotal to the success of an organisation.  Many tasks require a high level of professionalism and education, and some require commercial or political acumen.

blog 3

Within universities, secretaries, clerical workers and administrators have had to acquire specialist skills and knowledge.  We have had to learn on the job, using advanced computer systems and communications.  We have taught ourselves to become experts on university funding, teaching and research initiatives.  The corporatisation of universities has had a profound impact on the way HE institutions operate and our roles have been affected. Our roles have changed to those of higher education professionals and we daily respond to changes, pursue complex tasks, deliver innovative solutions, facilitate learning and development, drive the student experience and effect outcomes.

When universities were established in the 60’s, secretarial/clerical workers’ jobs were much more about paper pushing.  Nowadays, we are much more multi-skilled and we do all the functions ourselves.  The expertise of this body of staff is crucial to the core of the university’s structure and I believe that the professional administrative service is integral to the strategic success of the University of Kent.

Talking to colleagues, here are some anecdotes about how work has changed:

“Our work is often project-based, or we work as a team member on other projects”

“On a daily basis, I am asked to think outside the box, solve problems and come up with new solutions

“Nowadays, I’m always thinking about the bigger picture”

“I manage my own work”

“I make autonomous decisions effecting the way things are done within the university”

It is often the female, clerical and administration team who are the experts at the “soft skills” and the “specialist skills” – counselling the students, greeting visitors, doing the ground work for projects, managing student admissions, balancing the finances, writing the press releases, overseeing course administration, brokering student employment initiatives – all skills which can easily go unnoticed.

It begs the question, if one of these skills was performed by a man, would it have a grand title and be better paid?  We often associate the word “manager” with one who controls.  Feminine administrative functions are perceived as nurturing – feeding, nourishing, supporting, and furthering the development of.  Nurturing is usually quietly done, with much of the work invisible – and this clearly aligns with the perception that clerical and administrative functions can easily go unnoticed and be undervalued.

The Times They Are A-Changin’ – Part 2

Secretary-typing-in-old-f-007

For generations of women, secretarial, clerical and administrative skills were valued as essential skills that would be advantageous in the job market and help your career.  The major shift has taken place in relation to class and gender.  Originally, and prior to the 1930’s, nearly all secretaries were men and the role of secretary was deemed in high regard as an executive servant of the government. Clerical work was a male dominated field in which males worked closely with their superiors and were often apprenticed to them; their superior’s success was their success, and they could look forward to a position of management in their later years.  After WWII, when the men returned, secretarial and clerical work was seen as “feminized” and clerks were renamed “secretaries” and “typists”.  Both the pay and the prestige for these jobs took a significant hit!

Through the 1980’s/90’s, many secretarial roles were rebranded as administrative assistants and more men started to apply for such jobs, though in tiny numbers.  Technology evolved – word processing made writing and editing documents much simpler and with the arrival of computers, “typing” became “keyboarding”. Fast forward to 2015, and here you will find that most organisations have ditched the term “secretary” in favour of clerical worker, or administrative assistant/officer, or office professional, to encompass a more executive role.

Universities have adopted the term ‘professional services’ to distinguish staff not having direct academic responsibilities, with the term “administrator” being reserved for staff undertaking clerical or secretarial functions. Currently within Higher Education, there is much debate about the value of junior level clerical and administrative staff, who often consider themselves underpaid, overlooked and invisible.

Yet in the digital age, the roles of clerical and junior administrative HE workers have evolved far more than any job title change suggests.  We’ve experienced massive changes (see Part One of my blog),  including the growth of information technology, changes in the delivery of higher education and the development of a commercial and enterprise culture in Higher Education.  Academic staff have begun to delegate more tasks to clerical/administrative staff and such staff are increasingly playing a role in training and teaching students both informally and formally.   Today’s university administrative worker is responsible for a greater array of complex tasks than any predecessor!

 

The Times They Are A-Changin’ – Part 1

My university is celebrating 50 years in the business (1965 – 2015) and as such, I thought it would be a timely opportunity to showcase just how much the secretarial/clerical and administrative function has changed in the last 5 decades.  During that time, I’ve not only studied here, but through both varied, temporary and permanent posts, I have contributed over 18 years of secretarial, clerical and more latterly, senior administrative expertise to the institution.

The Times They Are A-Changin'

During my tenure, I’ve witnessed massive transformations in Higher Education, including changes to funding, increased student numbers, governance, increased corporatisation and commercialisation and the adoption of managerial models which has affected staff at all layers.

If you look at the workforce that I’m talking about, you will not fail to notice that we are a predominately feminised workforce and this can partly go some way in explaining our lack of visibility and some of the problems encountered along the way by us (e.g. a belief that we are not interested in academic endeavours or systems.  Unfortunately, some outdated stereotypes also exist (see my blog ‘Just an administrator‘)  but at least in the 21st century, we are able to challenge some of the long-held masculine views/behaviours on the definitions of female administration roles (i.e. being administrative and being female – i.e. not male and not academic!)

Many universities in the UK were established in the 1960’s and along with them, the roles of the university secretary and clerical/administrative worker were borne.  Such roles were referred to as “non-academic”, yet the mere use of the word “non” conjures up negative associations and leads to the labelling and definition of a whole section of the work force in describing what we “are not”, rather than what “we are”.   Back then, the university secretary/clerical worker was very much expected to operate in a subservient, supportive role to the academic community.  Role holders were expected to be seen and not heard, much like the women and children from the Victorian era.  Essentially their role was to look after the academic, type correspondence and make the tea.  Secretarial/clerical staff performed tasks such as typing, often supporting just one academic.  There were no student recruitment, marketing or international offices.  Finance and personnel departments were very small and invisible to the academic community.

Indeed, the role of the secretary/administrative assistant has enjoyed something of a renaissance lately in popular culture – take for example the characters of Joan Holloway and Peggy Olsen, the competent secretaries at the fictional advertising agency in Mad Men set in the 1960’s in the States.  Both rise up through the ranks to become meaningful employees – one to become a partner in the agency, one to become an advertising professional (on a perceived equal footing with the male characters).  Likewise, think of the term “Secretary of State” where the word secretary defines a senior official of the federal government of the USA!

Interestingly enough, the word secretary is a unisex word and isn’t defined by gender, although it is stereotyped to be female by association.   The title of secretary was originally used by military leaders, heads of state, and even popes to refer to their most trusted confidants – to the ones they could trust and rely on without reservation.  Secretaries were set apart from others and known to be favoured by their respective leaders. Later, secretaries were used in the same sense by professional and business leaders.

If we look at the history and significance of the word “secretary”, it can be traced to being used in Middle English as early as the sixth century and comes from the ancient Latin word secretumi,  meaning keeper of secrets!

Next month, part 2 of this blog will examine the evolving professional role of secretaries  in the 1930’s, 50’s, 80’s and 90’s through to the digital age.

Good Performers will fail in a bad system

Examples of failing systems are numerous, although often the finger of blame for failure is pointed at the people who are at the sharp end (for example, over-worked social workers spring to mind).

ladder of success people

If we cast our minds back to the pre-2012 Olympic Games security shortfall scandal, the British Army had to bring in thousands of troops at the last minute to work as security staff at the venue entry gates, due to critical shortfalls in numbers of trained security personnel promised by a commercial provider. This shortfall was not caused by a lack of recruitment, but apparently by failures in the system of appointing people into the jobs, plus late scheduling of training and induction to prepare recruits to start on-time in their role. Allegedly, some new recruits were never confirmed dates to get their training, others, despite being recruited months before the Games did not complete their training until just a few days before the Games programme ended (so late were the arrangements that many recruits didn’t bother to attend since the Games had only a couple of days to run,  and some people had already found jobs elswhere). These failures were not “nobody’s problem” – they were the problem of managers in the security company.

In a blame culture managers will identify the problem as being the people at the sharp end (so blame those pesky security recruits for not showing up to training just before the Games ended – what a lack of commitment!). Blame is both a self-fulfilling and a self-deluding philosophy.

There is a neat way to define the power of the system, versus the expectations placed on people, in a quote which I understand is attributed to Geary Rummler:

    “Put a good performer in a bad system
and the system wins every time”

But why blame the manager, then? Well, simply, because their job is to manage the system (and to improve it). In fact, that is pretty much all that their job should involve.

Further reading:

Deming W.E. (1982) Out of the Crisis, MIT CAES, Cambridge MA.

Rummler G. and Bache A. (1995) Improving Performance: how to manage the white space in the organization chart. Jossey-Bass, San Francisco.

Does ‘Best’ method always mean ‘best’ results? Impacts on Service Exellence

Does one size fit all?
Does one size fit all?

Best practice standards are commonly seen as a sure-fire route to successful improvement. After all – who could question the value of implementing best practice? If you are by now used to my writing style (after 3 years of output) you will have guessed that I am one person who would question the value of ‘best practice’.

Why question it?

Any method has to make sense in the context and purpose of what it is trying to deliver. Best practice in cleaning tables might be vital in preparing an operating theatre but might be excessive, costly and irrelevant when applied to a door making factory. The purpose of the work is important. Best practice in answering a phone call succinctly, clearly and efficiently might be the last thing that a service caller with an unusual problem wishes to hear.

I can remember being told by a customer service clerk, when attempting to return a clothing item in exchange for a refund or credit note, that “the company’s returns policy was recognised as best practice in the sector” – but sorry – no I could not have a refund (they suspected, or should I say assumed, that I had already used the item – which I plainly hadn’t). Their answer was no answer and no help to anyone (I did eventually get my refund).*

In services you need to build in flexibility. This means that you have to think carefully about what your users want and therefore what you must do to meet that need – otherwise a poorly considered method will not deliver what is really needed. Deming always used to ask ‘by what method?’

Over and above this, if you do implement a standard way of working, you tend to build in both rigidity (a lack of flexibility to meet differeing needs) and you push users’ experiences further away from the ideal. Seddon states “Don’t codify method” in services – in other words don’t write it all down and demand that everyone sticks to the written code.  But why  – surely standardisation will ensure quality (especially if the standard is shown to be best)?

Imagine – you call a service centre with a particular query in your mind – the telephone menu asks you to press 1,2 or 3 for different services, then at the next menu another 1,2,3. Even if you get through cleanly to the final stage do you really feel satisfied as a user? And what about the false trails, the accidental hangups or the misdirection to the wrong department? It all gets a bit depressing and, frankly, wasteful.

 Even in Ofsted inspections of schools, the error of inspecting and expecting a best method of teaching is now discouraged since the method is dependent on the learning needs and nuances of the students at the point of the teaching intervention. Yes – it figures.

To paraphrase Mitch Ditkoff, when imitation replaces creativity, something invariably gets lost – and innovation eventually goes down the drain.

Deming, W.E. (1993) The New Economics, MIT CAES, Cambridge MA.

Seddon, J. (2005) Freedom from Command and Control, Vanguard Press, Buckingham, UK.

http://www.bbc.co.uk/news/education-26161340

 

*P.S. As I gave my explanation they could see my receipt where the value of other items I had bought (with no refund requested incidentally) far exceeded the value of this item by about a factor of 5! As a clearly ‘valued’ customer (read: insulted) I chose to withdraw my custom from that outlet – for about 15 years – the lifetime of family clothing purchases – not out of spite, I may add – I just lost any sense of preference to buy from that store.

 

Improving service starts with a leap of fact, not faith

  • Leap of FactWhat should we improve and why?
  • What has changed?
  • How do we improve things, where … when?
  • Who should we involve?

If we start to address these questions and filter out assumptions and  preconceptions, we are able to make some sensible decisions about how to make effective changes that will have a positive effect on performance.

The world is not perfect and we are unlikely to always have the time and resources to gather the complete picture of what is happening. Nevertheless it is important that we seek out and analyse relevant data in order to make some reasonably robust assumptions about what we can do.

There are two common failures of action, lets call them type 1 and type 2 (which is what statisticians call them), or perhaps a mistake in identification between ‘common causes’ and ‘special causes’ of variation. Without understanding the difference we risk just ‘tampering’, where we feel like we are doing something useful but actually only making things worse (Deming, 1982).

“Common Causes”

Common cause situations are those where performance goes up and down over time and if analysed properly can be seen to occur over a relatively predictable pattern: if we change nothing, the performance level will most likely continue. The problems arise when  someone thinks they see a real difference between points of data when in fact no such thing exists. This a type 1 error: we observe  a change which is really only a natural effect of background ‘noise’ yet we choose to act on that ‘change’. For example someone in the office achieves a great result whilst others do not achieve the same result. Is the difference because of the person, or something else in the wider context? Perhaps, as is often the case, they just got lucky and happened to be the one that achieved the good result. Next week it might be someone else. The analogy  is a fire alarm going off indicating a fire when in fact there is no fire. It is easy to fall into type 1 errors assuming highs and lows of performance which don’t exist. This is a ‘mistake of commission’  – doing something that should not have been done (Ackoff et al 2006).

“Special Causes”

Some special causes are obvious, for example a major increase or decrease in performance or a freak accident. However, sometimes hidden patterns of performance can indicate a real change which might easily go undetected if we consider each data point as a ‘one off’. This is a bit like a fire breaking out but the fire alarm not ringing. The fundamental problem is that these genuine changes are due to ‘Special Causes’ something real which is impinging on the system. The issue here is that the solution sits outside the system – don’t redesign what you have as it will not replicate the situation – that is just meddling and will make things worse. For example, cycles of deteriorating work output followed by improving work output by one person might indicate an underlying special cause which needs to be addressed (health for example), so meddling with the design of the work in itself would be counterproductive. Furthermore if the manager does not look at performance over time, these cycles might not be detected anyway – on average they might look like a reasonable level of output. Ackoff calls this a mistake of omission – not doing something that should have been done.

Of course to detect differences between special cause and common cause varuiations in performance requires new skills and disciplines of thinking. When you understand the organisation as a system, improving service starts with a leap of fact, not faith.

Reading:

Ackoff, R.L.; Addison, H. J. Bibb, S. (2006) Management f-Laws: How Organizations Really Work. Triarchy Press

Deming W.E. (1982) Out of the Crisis, MIT CAES, Cambridge MA.

Seddon, J. (2005) Freedom from Command and Control, Vanguard Press, Buckingham, UK.