Wednesday, 28 May 2014

Stop the line and fire the middle managers!

The Japanese have always been ahead of the game when it comes to production. The Toyota Way is a method of lean production that puts quality at the heart of everything and any staff member is allowed to 'stop the line' if they feel quality has been compromised. Another new(ish) concept is agile marketing and management. Agile development has been borrowed from project managers, particularly those involved in IT projects, and adapted for use by businesspeople and marketers. Jim Ewel, a fellow marketing blogger says:
"The goals of Agile Marketing are to improve the speed, predictability, transparency, and adaptability to change of the marketing function."
The key principles of agile marketing are the ability to implement change quickly, trusting staff to have the knowledge and ability to get their tasks done, continuous learning through feedback, and perhaps most interestingly the acknowledgement that you might fail, that's okay, but you shouldn't fail the same way twice. Again, learning and using feedback are ways to avoid this.

These are all business concepts that would work for any marketing orientated organisation and we can learn from them, however, what happens when a different kind of organisation adopts these principles?

Well, it can be an amazing success as I was delighted to read today in the national press!  My local hospital, Hinchingbrooke in Huntingdon, was taken over as a NHS franchise by a private equity health organisation in 2012 after extensive problems had been revealed. It really was a failing hospital - in terms of health care and its appalling finances. Now, it has been named as the top hospital in the country for care and will make a profit of £2 million this year.

Thankfully, none of my family has been treated there so far but we dropped in recently to use their cafe and to pass the time before we picked up our daughter. We were amazed that this was what an NHS hospital could look like. It looks like a cross between IKEA and a Premier Inn. High gloss, calm, clean, comfortable chairs, an environment that makes you feel like a human and not a prisoner unable to escape from the harsh lighting and sterile conditions. We had our frothy coffee in the Costa Coffee that looked identical to a high street branch!

The reason for this transformation has been running the hospital like a John Lewis partnership. Everyone has a say and the ethos of the hospital was based on a group discussion with 1,200 of the 1,700 staff - 500 didn't turn up but were invited. The front line staff who are responsible for delivering care are now empowered to solve problems in their wards immediately and without the need to get approvals from long chains of middle managers like standard NHS hospitals. In fact, the middle managers have been stripped out and the board is made up mostly of clinicians.

Queues in A&E have been reduced as computerised systems flag up patients who have waited too long - similar to systems used in Argos where the CEO used to work. Motivation is now high, staff are happy and patients even happier. The feedback process is constantly monitored and testimonials are pinned to the notice boards.

Quality is at the heart of patient care and the Toyota Way has been implemented too... anyone involved in patient care can say 'stop the line' if they think a mistake has been made which to date has stopped failings such as swabs or instruments being left inside patients after operations - something which happened in the days before the takeover.

The reason this change has been so transformational is that the business experts have concentrated on fixing the finances and delivering systems that can sort out major issues like queues or poor quality. They have given everyone empowerment and the chance to make the changes that are needed to put patients first. And they have sensibly demonstrated that clinical decisions should be taken by clinicians. Is it rocket science? No, not really - just good business practice applied to a different kind of organisation. The big question is why is this not applied to every NHS hospital in the country? The answer to that, dear reader, is politics and that is not a question I feel qualified to answer.

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