Managing Value in Organisations by Carroll Donal;

Author:Carroll, Donal;
Language: eng
Format: epub
Publisher: Taylor & Francis Group
Published: 2012-08-15T00:00:00+00:00

Hidden Connections: How the Three Models are Interconnected

To demonstrate how the three models are interconnected, here is an illustration of their inseparability in practice.

For more than ten years, I have been attending a large NHS hospital in London as an eye patient. Over that period, I have seen the reduction of staff and at least a doubling of patients. The eye clinic has had various makeovers. This particular hospital is notorious for losing patient records though the IT system does now seem to work. It has tried different forms of management models, beginning with the ‘because I can’, where nurses take out their passive empowerment on patients with a bellowing crowd management approach which moves them round the room for no effective purpose. Next was silent management, with administrative staff being left to explain why patients cannot be seen and finally, modern management where three different services connect only at the end when a consultant pronounces on the information gathered from the other services. All the different systems ‘work’ but in a disconnected way, creating a fraction of the value they could – a key concept in this work. Only consultants can make ‘knowledge judgements’ even though staff at each service are quite capable of explaining the meaning of the various test results and are regularly asked by patients to do so.

Here are some typical exchanges in each of related services (or systems):

Eye testing: Have you taken your drops? Yes. What are they called? XYZ. When did you take them? 9am. Pause. I ask if there isn’t another question she should ask me. No. Well, I say, you could ask are they having any effect? That’s not my job, she says ending the exchange.

Field testing: I say to the nurse that I notice this test seems to take much longer. It took eight minutes she says. I ask is that longer thant before? Yes, she replies, looking at my previous records. What does that mean, I ask – a deterioration? The consultant will tell you, she says. Are there more gaps, I ask, pointing at the printout she has? The next patient is coming in and needs to be seated, she says, ending the exchange.

The consultant: I ask why the other service staff cannot give details and results of the tests they supervise and what it means. I do that he says. But couldn’t they keep the patient informed and enable them to better self-manage? Maybe, he says, cautiously, but that assumes some things… remember the best minds do not come into the NHS! With his concluding diagnosis – little improvement and more of the same treatment – I ask him where the ‘best minds’ do go and shouldn’t this hospital be developing them?

In this instance, improving patient service requires amending or, more likely, completely reinventing the three models:

Management model: organising effort better – this needs to move from ‘not my job’ to how silly it is if it is not, and how much more efficient it would be if I was allowed to impart standard information to the patient.

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