Category Archives: Excellence

Change Principles, Culture, Excellence, Professionalism, Service

Lessons from Florence Nightingale 200 years on…

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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

 

Change Principles, Excellence, Process Improvement

Systems ignorance and unintended damage

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Cause and Effect Analysis is often considered a comprehensive approach to addressing problems and identifying solutions. This approach is true in closed systems where linear cause-effect relationships typically occur. Many areas of manufacturing and assembly would fit into this model.

Most work situations do not occur in a closed system but instead are in open systems where many factors affect an outcome.

Ishikawa recognised this in his ‘fishbone analysis’ approach to problems. He recognised that many causes, and layers of causes  can affect an outcome. He also advocated for the collection of data on causes and outcomes before relying on an intervention to have a desired affect.

If we ignore this advice we will implement actions which will have unintended consequences. Send a ‘communication’ and it is interpreted as a threat. Give a pay-rise to one person and it is seen as a betrayal of trust by a dozen other people. Instigate an inspection system and it generates a new industry (and associated cost) to the sector. Seek to drive down costs by reducing resources and it will increase costs by causing repeated failures.

If you have a lunchtime to spare it is worth listening to Peter Senge’s discussion about systems in organisations:

Peter Senge’s keynote speech “Systems Thinking for a Better World” at the 30th Anniversary Seminar of the Systems Analysis Laboratory “Being Better in the World of Systems” at Aalto University, 20 November 2014.

Change Principles, Excellence, Leadership, Process Improvement

Leadership lessons from Deming

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It is 90 years this month since Ed Deming completed his PhD in Physics, but it is his work with statistical understanding of processes and performance of organisations, and its impact on human behaviour and leadership which is his lasting legacy. Deming was alays open to learning new things, up to the end of his life at the age of 93 – a lesson for us all.

A few important concepts which he identified for leaders include:

  • 90% of problems are cause by the system – and the system belongs to management
  • Banish any form of individual ranking or reward because 90% of variation is due to the system and not individual performance.
  • There is no substitute for knowledge. Seek knowledge not opinion or assumption.
  • Engage people in change. From day-to-day activity they know the problems and issues of work better than managers. Give them the measures to understand the activity and they can better make efforts to improve it.
  • Best efforts tend to cause problems. If we just ‘try harder’ it is likely to make things worse, unless we change the system of work
  • Drive out fear. Innovation, ideas, creativity enable high work performance. Fear crushes all of these things.

Reading:

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

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

Voehl, F. (1995) Deming the way we knew him. St Lucie Press, FLA

 

Excellence, Leadership, Process Improvement, Service

Costs are found in flow – not within activities

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 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.

Culture, Excellence, Leadership, Process Improvement, Service

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

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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.

Excellence, Service

You couldn’t make it up!

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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.

 

Culture, Excellence, Leadership, Process Improvement

Avoid the ‘bolt-on’ management method

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Maybe not the best way to improve management

Sometimes approaches to managing people simply do not work. However, I have heard people defend the failure of particular management approaches (like appraisal, ISO9000, quality circles etc.) by saying ‘its because it is not being done right‘. While this may be ‘true’ (in the sense that successes can occur), I think that a more circumspect approach must be taken when considering these methods:

  1. If it doesn’t’ work, is this failure a generally observed occurrence? (i.e is it something that predictably fails)
  2. Is it only failing on an unusual, ‘exception basis’ – once in a while?
  3. Might the approach be fundamentally flawed?
  4. Could there be a better way of achieving the desired outcome (assuming the desired outcome is genuinely that the manager wants to do a better job of managing) – in other words is the well-meaning manager barking up the wrong tree?

The problem with bolting ‘good’ approaches onto bad is that it proliferates the work of management, which adds cost, hassle and meddling with the real work (of serving customers, providing public services, educating, making cars, or whatever is our business).

Treating people well, usually involves doing something (‘nice’) to compensate for the default situation, where they suffer some sort of indignity, disappointment or frustration as the general state of affairs. The ‘nice’ idea masks the fundamental problems.

John Seddon openly criticises this type of woolly thinking – not because he thinks people are not worthy of being respected and treated with dignity, but because the respect and dignity should start in the way that their work and the system they work within is managed. In other words:

  • don’t punish people for things out of their control,
  • don’t design work to frustrate them from doing a good job,
  • don’t waste their time.
  • don’t make systems which expose them to unnecessary grief
    (from customers and users)

Deming used to talk about dignity (long before most others used the term) and, as shown throughout his writing, appears to assume that everyone would be following the same ethos. Doing a ‘respect for people programme‘ would, to Deming,  be absurd. Just as doing appraisals would be absurd, or adhering to standards, or setting targets. What do these approaches say about what managers really think about their staff (lazy? untrustworthy? unmotivated? stupid?)?

Some things in life are worth restoring and refurbishing, even upgrading. But others are just so fundamentally flawed that an upgrade is not worth the effort. The same can be said for many management methods.

Just make sure that you are not applying bolt-on management.

 

Helpful reading:

MacDonald, J. (1998) Calling a Halt to Mindless Change, Amacom, UK

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

 

However, the alternative perspective is offered by Bob Emiliani:

http://www.bobemiliani.com/kudos-to-john-seddon/

 

Culture, Excellence, Integrity, Leadership

Experience versus Vitality and Innovation

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Daniel Sturridge, Steven Gerrard & Chris Smalling

‘Experience’ is an often-quoted strength in a job candidate or team member.

If this is relevant to the work that needs to be done, then great. However the term experience is often read as ‘knowledge’ and that is not always the case. An experienced person may refer back to situations that are not relevant to the present. An experienced person may rely on apoproaches which are not the best, but which merely work ‘OK’.

An experienced person’s views may now be out of date. In the 1960s a Japanese delegation visited a British car factory in the midlands and were guided around the operation by a proud production manager. The visitors had many questions about the facility and how it worked but felt they were not being given the answers that they wanted. One of the Japanese vistors asked the manager ‘How long have you worked in this factory?‘ to which the manager answered ‘Over 20 years!‘.

The Japanese visitor was oveheard to mutter ‘more like 20 minutes…‘

The manager did not know what was really happening in the production facility – they did not have relevant knowledge, nor an understanding of how to improve the work or quality of output.

A valuable, experienced professional is one who has the humility (and experience!) that allows them to ask the right questions and not to be the source of all the answers.

Reading:

MacDonald, J. (1998) Calling a Halt to Mindless Change, Amacom, UK

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

Excellence, Leadership, Trust

Self-Determination and Intrinsic Motivation

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Dan Pink’s 2009 talk on The Puzzle of Motivation was one of the most-watched TED Talks (see the video link above) and draws from the ideas he researched for his book ‘Drive’. In the book he explores the research around aspects of intrinsic motivation which he divides into autonomy, mastery and purpose. 

This knowledge of human behaviour counters traditional models of motivation driven by rewards and punishment (i.e. ‘carrot and stick’) which are dominated by a focus on external factors such as pay.

This new thinking around motivation is based around Self-Determination Theory (see Ryan and Deci, 2000), although the origins also link back to the core ideas of systems thinkers and practitioners such as Deming, who was also a student of psychology.

A sense of purpose is essential for people to focus their work AND to give meaning to their work (Deming 1994). Autonomy involves the opportunity to influence the work that is being done and is based on an ability to make decisions using information to hand.

As Pink points out, any work  requiring some degree of cognitive ability (i.e. aside from the most menial), will see higher worker performance when degrees of autonomy, mastery and purpose are increased.

Reading:

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

Pink D. (2009) Drive: the surprising truth about what motivates us. Riverhead Books.

Ryan, R.M. and Deci, E.L. (2000) Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being. American Psychologist, 55 (1): 68-78.

Other links:

Motivation revamped: a summary of Daniel H. Pink’s new theory of what motivates us

 

Change Principles, Culture, Excellence, Process Improvement

Happy staff, happy work ; happy work, happy staff

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santaTo paraphrase Richard Branson, ‘happy staff = happy work’, and for Branson, that means that customers will also be happy and your organisation will be successful.

Motivational theory and systems theory tells us that a work (the way it is designed and the constraints placed upon people doing it) also influences whether people are satisfied with what they do. In other words, happy work creates happy  people.

Deming talked about dignity in work decades before it became a focus of attention in Human Resource departments. His philosophy was ‘centered on people and the dignity of work. He believed that people should have joy in their work, that the system within which they work should be designed to make this possible and to enable workers to reach their full potential to contribute to the enterprise‘ and that system is management’s responsibility (Tortorella, 1995).

So for happy also read ‘joyful‘. Quite an expectation! But consider this: whilst a happy person is satisfied, a joyful person brings renewed energy and vigour into their activities, interests and relationships – exactly what we need in a high performing team. And a joyful person can be as quiet and dignified as they wish, or as outwardly enthusiastic as they wish, but their joy will rub off positively onto the people around them.

It is motivation…for free.

Reading:

Oswald, A.J., Proto, E. and Sgroi, D. (2014) Happiness and Productivity. http://www.econstor.eu/bitstream/10419/35451/1/522164196.pdf

Nazarali, R. (2014) Happy People are more Productive. http://ridiculouslyefficient.com/happy-people-are-more-productive/

Raymundo, O. (2014) Richard Branson: Companies Should Put Employees First. Inc.com, OCT 28, 2014. http://www.inc.com/oscar-raymundo/richard-branson-companies-should-put-employees-first.html

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

Tortorella, M.J.  (1995) The Three Careers of W. Edwards Deming. Siam News https://www.deming.org/content/three-careers-w-edwards-deming