“Making the numbers” is important in business. Whether we’re talking about commercial performance, quality of service provision, compliance with legal and regulatory requirements, or whatever, numbers matter.
At the same time, knowing the numbers gives us little clue as to how best to manage business performance on a continuing basis.
When we’re talking about the complex social dynamics of organization, numbers don’t cut it. To paraphrase Peter Drucker, only the notation is numerical, the decisions are entrepreneurial1. That is to say, managing business performance is about committing resources today, to deal with a continuously emerging and ultimately unknowable future.
Yet we still appear to be locked-in to a view of business performance management that is rooted in the ‘if you do this, you’ll get that’ logic that properly underpins the management of technical performance.
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Keogh report comes closer to recognizing the complex social dynamics of hospital practice
In my recent paper, Taking Organisational Complexity Seriously, I criticised Sir Robert Francis’s recommendations arising from his inquiry into the Mid-Staffordshire NHS Trust. I argued that these were too focused on “the system” and not enough on the everyday, local interactions between practitioners, patients and others through which outcomes emerge in practice. I suggested, that a better response might have been,
Thankfully, the subsequent review of practices in a number of other NHS Trusts by Sir Bruce Keogh seems to have adopted just such an approach – at least for the most part. Most importantly, his recommendations appear to be focused on the specific needs of those staff in each hospital and Trust whose job it is to deliver the necessary quality of “clinical effectiveness, patient experience, and safety”.
Although the shameful bickering and thinly disguised point-scoring that took place in the House of Commons in the immediate wake of the report’s publication might have suggested otherwise, the language in Keogh’s report is measured. And, pleasingly, his grasp of the complex nature of the dynamics involved in ensuring high-quality care is laid bare in his report:
In his covering letter to the Secretary of State for Health, Jeremy Hunt, he further seeks to debunk the idea that such abstract measures as the Summary Hospital-level Mortality Indicator (SHMI) or the Hospital Standardised Mortality Ratio (HSMR) can be used to quantify actual numbers of “avoidable deaths” or to relate these to inadequate levels of care:
Despite this, of course, this is precisely the use to which such measures have been put by politicians and media commentators alike!
So, at first sight, Keogh’s review offers the hope that more recognition might be given to the complex social reality of everyday hospital life through which care is ultimately provided. At the same time, though, he fails to challenge the need for the plethora of organisations that surround the provision of health-care services ‘on the ground’. In doing so, I feel that more emphasis is still likely to be placed on the checking-up of practitioners’ compliance with generalized rules and standards imposed by these 'arms-length' bodies than on helping them to deal with the specific realities that they face in the midst of ‘live’ practice.
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Posted on 24 July 2013 in Complexity, Current Affairs, Leadership, News Commentary, Performance Management | Permalink | Comments (0) | TrackBack (0)
Tags: Keogh report; NHS; organizational complexity
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