Recent press stories about low standards in some NHS hospitals, where up to 12 hospitals have been judged inadequate by the semi-autonomous body Dr Foster’s, have once again raised questions about targets, inspection and standards. We have been treating similar themes in this blog (see below The Tyranny of Targets and Performance Measures). The discussion has become much more animated in a context where standards of hygiene and care have more than just nominal implications, but can make the difference between life and death for patients. The debate seems to swing between two poles: on the one hand, the argument goes, it is no longer enough to rely on self-assessment, since some of the failing hospitals judged themselves excellent. Therefore the right approach must be more stringent, on-the-spot inspections. This is an argument for adding to the bureaucracy of inspection. The more free-market argument is to encourage the public to vote with their feet, and to stop using hospitals that fail to meet basic standards. As consumers we are encouraged to exercise our right to ‘exit’ the service. Neither approach seems to ask what kinds of work practices allow highly trained professional staff to ignore what must be very obvious to them in terms of low standards. To what extent does the practice of government ‘naming and shaming’ and the anxiety that this evokes in top NHS managers encourage them to prevent staff pointing out the obvious for fear of jeopardising the hospital’s reputation? How possible is it to speak out in hospitals even if what one has to say is unpalatable? Neither inspection nor consumer exit deals with the ethical responsibility of staff in situ, both managers and health professionals to find ways of talking about and dealing with the difficult situations they find themselves in together.
I was working with some teachers in a school the other day when the conversation turned to inspection and evidence. The new UK school inspection regime is based much more clearly on teachers’ and managers’ assessments of how they think they are doing – they have to fill in what is called a SEF, or self-evaluation form – which is then offered to incoming inspectors as the primary basis for their inspection. According to the Department for Education, evidence has to be rigorous, has to be written down and has to demonstrate ‘impact’. The inspectors then judge not just the quality of teaching and learning in school, but also the quality of the SEF. The idea is that the inspection becomes an assessment of teachers’ ability to assess themselves in the given form of the SEF.
Since I have taken a long-term interest in encouraging reflection and reflexivity in the posts in this blog , I was interested to note my own resistance not to the idea of self-evaluation but to the way it was being put forward and the ideology of relentless improvement and scrutiny that it implies. Continue reading
The following post is written by Rob Warwick. Rob works in areas of strategic change in the UK’s National Health Service. He is particularly interested in how policy makes its way from Government to the front line. This is currently the area of research for his doctorate with the Complexity Management Centre at the University of Hertfordshire.
There has been much talk in the UK press recently about spending cuts to curb public expenditure as a result of the recent economic downturn. Politicians talk of 5%, 10% 15% cuts – conveniently rounded numbers. What is absent is the detail of how this will or could play out. Whichever government comes to power after the general election is likely to take these rough (but neatly rounded) percentage figures and turn them into targets, budgets, action plans and the like. It reminded me of a book by Michael Barber called Instruction to Deliver, retelling his account of how he led Tony Blair’s “Delivery Unit” after the 2001 General Election. A book comes with a new word “Deliverology” and a “Delivery Manual” at the end. I don’t intend to write a book review here, but I would simply like to point out how little the actual experience of the practitioner (the teacher, nurse, or even the manager) features. Take for example the then Health Secretary’s (Alan Milburn) mission: “He was very clear what his task was – to drive through the reforms, take on the vested interests, bring in private sector providers …and build on … choice … to ensure results were met” (Barber, 2007, p132). No mention of what was valued by nurses or doctors as practitioners whose job it was to make people better. Continue reading
A group of economists at the London School of Economics have felt impelled to write to the Queen in response to her question posed a year ago when she was on a visit to the university as to the cause of the banking collapse.
The letter explains that there was a ‘psychology of denial’ affecting all those concerned, and in a touching note of humility drawing attention to the fact that many very intelligent people were caught up in this collective denial, the letter goes on to explain that “it is difficult to recall a greater example of wishful thinking combined with hubris”.
“Everyone seemed to be doing their own job properly on its own merit. And according to standard measures of success, they were often doing it well,” they say. “The failure was to see how collectively this added up to a series of interconnected imbalances over which no single authority had jurisdiction.” (my emphasis added) Continue reading
John Seddon’s book Systems Thinking in the Public Sector is a well-written and powerful reminder of the limitations of targets and performance measures in public services. Targets, he argues oblige managers to pay attention to the wrong things, what politicians require rather than what local service users need and this leads to perverse consequences. Targets prevent staff from dealing with the variety of what they encounter by obliging them to serve inflexible and predetermined rules which have been set by someone else sitting outside the situation that local staff and managers are dealing with. Targets and performance measures arise out of an ideology of control and a pessimistic assessment of public sector staff: that if civil servants are not standing over them with exacting standards then somehow they won’t do their jobs properly. It has resulted in what he describes as an army of bureaucrats whose job it is to specify, inspect and report compliance on targets and measures which are driving public services away from what the public really wants and needs. In these ways this approach has contributed hugely to waste and cost.
He describes the difficulty he has had of getting many of his ideas accepted because setting targets has become axiomatic – to suggest that setting targets is the cause of many of the problems rather than the solution to the problems is to present oneself as being eccentric. Seddon points to the ways in which other ungrounded idelogical obsessions, that consumer ‘choice’ is the best way to develop services, that IT is always a cheaper option, that the private sector will always deliver a better deal for service users, have come to dominate decision-making and management in the public sector. Continue reading
In a similar vein to the last post, I came across a report which has been produced recently on the education of 14-19 year olds in Britain entitled Education for All. One of the themes of the report is the way in which the language and concepts of management have prevailed in the sector and in doing so have reduced the understanding of what education might mean:
“As the language of management and performance has advanced, so we have proportionately lost a language of education which recongises the intrinsic value of pursuing certain types of question, or trying to make sense of reality (physical, social, economic and moral), of seeking understanding, of exploring through literature and the arts what it means to be human…” Continue reading
In previous posts I have pointed to some of the difficulties that arise in the not-for-profit sector of importing management methods from the private sector uncritically. I have been suggesting that the imperatives of for-profit organisations are much narrower than for those organisations that are founded to do good with and for others. The ‘otherness’ of others and the importance of processes of mutual recognition immediately problematise any attempt to see social development, education or even health care simply in terms of the technical provision of services. The attempt to portray the process of social development using the ubiquitous word ‘delivery’ conjures up the image of passive recipients of pre-packaged philanthropy. I have tried to argue instead that the intentions of the institution and the needs and perspectives of organisational beneficiaries have to be construed in terms of their inherent mutual tension if the furtherance of the objectives of the organisation are not to be experienced by beneficiaries as a form of domination. As I have expressed it previously, the question might need to be ‘how does my vision and mission fit with the needs of this villager’, rather than ‘how do the needs of this villager fit with my organisational vision and mission.’ Equally, with the process of performance management I would like to suggest alternative ways for managers in not-for-profit organisations to think about what it is they are doing with their employees when they are trying to assess how well they are doing while doing good, in Moss Kanter’s phrase (1987).
In doing so I am trying to develop a richer understanding of what we might mean by the word ‘performance’ and its relationship to a more nuanced appreciation of social practice. In order to do so it it has to be linked to the more complex concept of time (that I have set out below) than that suggested by an if-then causality, and shows how context makes such a big contribution to what is possible. It also means reintroducing the manager and practitioner back into the field of practice and to understand how power and values make a considerable contribution to what happens in the interactions between people. KPIs, the Log frame Apporach , project cycle management, and performance management as currently undertaken in most organisations assume that employees have considerable power to design social change and to contribute to it in predictable ways. The job of management then is to encourage and motivate employees to fulfil these predictions, taking a more or less coercive attitude to those employees who fail to fulfil them. This way of thinking privileges the idea of the individual as a decontextualised and rational actor and places an increasing emphasis on achieving ‘results’. Whilst I would in no way want to suggest that achieving results is unimportant, I do want to put forward the idea that we cannot always be clear about what it is we are achieving, particularly as our intentions collide with those of others. I also want to argue that we constantly reinterpret with others what it is that we think we are doing, and it is possible that we might consider this week a failure what we thought of last year as a success.
Currently managers in organisations understand themselves to be people who can design an appropriate series of interventions to achieve a particular social transformation, which logically and rationally tee up particular activities and ‘behaviours’ on the part of their employees to achieve them. The idea of managing performance in this way of seeing the world could be reduced in caricatured form to a series of sticks and carrots to bend employees to the plan that was originally conceived, even to the degree of their every day behaviour with others. If organisations take money from large funders and work through other smaller organisations, as many international development NGOs do, then these ‘partners’ in turn need to be kept on the predetermined track and ‘held accountable’ for their part in achieving it. ‘Performance’ in these circumstances can tend towards conformity, which is ironic in those social projects which also claim to be striving for innovation. Management practice is conceived as a series of interventions to ‘close the gap’ between the expected outcome and the actual achievements, to correct progress towards the anticipated model of change.
The alternative view of agency and practice that I have been setting out in previous posts would understand the management process to be a product of the social milieu, the habitus, from which it emerges. So, the generalised tendency to produce ambitious and idealised strategies for social transformation by NGOs are very much a product of 20th and early 21st centuries, where philanthropy is highly marketised, and there is a strong belief in management methods based in systemic understandings of social change. The use of rational management theory is often accompanied by an appeal by way of employees’ values to the moral mission of not-for-profits in order to generate employee excitement and commitment. However, in my view, when taking up objectives derived from the strategy employees will be obliged, in pursuing them, to improvise with those they interact with. This is partly because the habitus of each different context will be different, particularly if the organisation has programmes overseas, but partly also because the meaning of the employee’s action can only be understood once their social counterparts have acted in response. In the gesture and response between the employee acting with intention and those they interact with a patterning of social action will arise, the exact outcome of which is unpredictable. The organisation’s objectives and the way the employee takes them up is not the only game in town.
Management intervention according to this way of understanding action would be to try and make sense with the employee of what has arisen as a result of them acting with intention, and to help them understand their own part in the game they are playing. How have they contributed to the patterning of gesture and response, and how has it affected them in their actions?