Freedom from Command & Control: Rethinking Management for Lean Service
Here is a fascinating post from John Seddon at his website www.lean-service.com (link is dead) about ambulances “making their numbers”:
The stupidity of measuring the eight-minute response time has been all over the press recently (you get a tick in the box for getting there in eight minutes even if the patient dies). People working in the ambulance service tell me this is causing some managers to send ‘technicians' who get there on time but can't help the patients (some die) and other managers work on what calls to ‘exclude' from the eight-minute measurement. The latter, of course, leaves them open to making the mistake of treating some events as not time-critical when in fact they are.
Sigh, that's familiar from the manufacturing world and the business world. Donald Wheeler talked about (quoting Brian Joiner, I believe) the three things people can do when pressured to improve the numbers:
- Distort the system
- Distort the numbers
- Improve the system
In the case of the UK ambulances, we have the first two happening. They distort the system by sending SOMEBODY in the 8-minute window. They distort the numbers by looking for cases to exclude for one reason or the other. Neither is a true system improvement, unfortunately. That's what we need more of in this world, actual system improvements, not distortions.
Here are some BBC stories on the 8-minute goal:
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[…] much as British hospitals cut corners and gaming the system to hit 4-hour A&E targets and 8-minute ambulance targets. Targets and fear-based management will lead to errors… but that management system is rarely […]