The More We Reduce Conversation, The More We Increase Demand

A few weeks ago I visited a GP surgery with a family member to discuss a few issues that had been bothering them. They were told – with no uncertainty – that they shouldn’t attempt to discuss more than one issue per appointment as they were limited to 10 minutes. It was stated that there was “no way anyone can deal with more than a single issue” within that time frame.

A letter in the British Journal of General Practice back in 2015 discusses the limitations of the 10 minute appointment. “When a patient’s problem(s) are not able to be safely and effectively dealt with in a 10-minute appointment there are only three possible outcomes: the problems are not adequately dealt with, they are dealt with but take longer than 10 minutes, or the patient is asked to make a further appointment.”

Indeed, as John Seddon has pointed out: ‘The effect of the rationing system is to make those in need keep presenting (creating demand that is not
going to be satisfied) until their problem becomes serious enough.’

Watching the GP at work I was reminded of the chapter in Radical Help where Hilary Cottam shadows Ryan, a recently qualified social worker, and observes that 74% of his time is spent on administration and recording and only 14% of the time with families he is meant to be supporting. She describes the question and answer session with one of his clients as being more like a ‘tetchy interview’ than a conversation.

You don’t have to be a service designer to be able to recognise when a system that was set up to serve the end user has flipped and is now in service to the system itself.

Last week a few colleagues and I had the opportunity to speak to a number of NHS leaders about Bromford neighbourhood coaching. The model focuses on spending time in the community, building connections through conversation, and has ‘caseloads’ about 70% smaller than the industry average.

I recounted that when I started working in housing you had one community visit day each week and the rest of the time (80%) was spent on office administration. Your ‘visit days’ were purely reactive , responding to things that had gone wrong during the other four days. I remember serving six notice of seeking possessions (effectively a threat to remove someone from their home) on a Friday afternoon, leaving some poor folk worrying all weekend with no way of contacting anyone.

The system had taken over from the original organisational purpose.

During the NHS session two of our coaches , Amy and Sinead, told powerful stories about what individuals and communities had achieved when relational approaches had been used that start – not with a 10 minute appointment or a form being filled in – but with a conversation. Rather than adding things (specialist teams, additional budgets, new policies, more ‘professionals’) they talked of fostering community connections, bringing people together to solve problems and empowering individuals to do things for themselves rather than being done to.

Amy told us of a resident who had been a tenant for over 30 years but had never been spoken to by their landlord in anything other than transactional terms. Through a conversation about her interests she was now running a community gardening club and looking after neighbours pets whilst they were in hospital. Sinead told us about bringing together a group of young mothers who individually had been dependent on antidepressants but when brought together collectively to plan community events and support each other had been able to move on from prescription medication.

Rather than just performing the transactional role of a professional they were strengthening the core elements that make up a community.

It’s not easy to change people’s mindsets from managing to connecting. It’s not easy to remove the scripts, policies and rules we have built around our institutions that suffocate creativity. It means investing in people and giving them the space to think and act differently. It means giving people permission to challenge preconceived practices and ‘rules’.

The social sector cries about being overwhelmed by demand but it is an entirely self created problem. Our services focus on needs rather than strengths, and as a result we have fostered dependency which in turn leads to increased demand.

Enlightened organizations know that people focused services build on existing strengths and promote responsibility instead.

The biggest problems we have across the social sector will not be solved by pouring more money on them. We need to rebuild the sector using the power of conversation and relationships. And you can’t do that in 10 minutes.

Photo by Priscilla Du Preez on Unsplash

The People Vs The System – and Why The People Rarely Win

What if we overstate the effect of the people in our organisations, and we spend too much time addressing what they feel and think without addressing the more complex, systemic problems that influence how they perform or behave?

The supposition is prevalent the world over that there would be no problems in production or in service if only our workers would do their jobs as they were taught. Pleasant dreams. The workers are handicapped by the system and the system belongs to the management

W.Edwards Deming

‘It’s all about the people. Our culture. Our values’.

This is a common cry from companies everywhere – proudly announcing to the world that they only hire the best. Come and work for us and we’ll let you make a difference.

It’s seemingly a meritocracy then. The best companies simply recruit better, more motivated people. So we should be able to solve problems like the NHS , for example, just through better recruitment and retention policies?

There’s an elephant in the room here: what if we overstate the effect of the people in our organisations, and we spend too much time addressing what they feel and think without addressing the more complex, systemic issues that influence how they perform or behave?

According to W.Edwards Deming 95% of variation in the performance of a system (or your organisation) is caused by the system itself and only 5% is caused by the people. This is also known as Deming’s 95/5 rule.

Deming’s point , outlined in his famous Red Bead Experiment, was that in most processes any effect that the individual may have is swamped by the system they are a part of, in fact the variability they cause is just part of that system overall. As management owns the system, the workers themselves have little influence over the outcomes. When it comes to people vs the system, the system always wins.

In his book Beyond Command and Control, John Seddon states the change HR – or any people function – needs to make is obvious. “It needs to work on the 95% of the system that governs performance, not the 5% that doesn’t.” The starting place for these functions is after the systems have been redesigned. In practice, the typical HR function spends most of its time dealing with the fallout of performance failure, or training people for a battle they can’t possibly win.

One of the best posts I’ve read this week comes from Steve Blank, who tells of his frustration in attending an “innovation hero” award ceremony. His point is that rewarding people for ‘innovation’ and how they have battled against the system is actually just perpetuating the conditions in the system that prevent innovation. “The emphasis is on process, procedures, and sustainment of existing systems. Deviations from that which create chaos and diverge from the predetermined are not welcomed, let alone promoted, and funded. They are eliminated.”  Smart organisations recognise that people must be empowered to change the system – and instead of managers of process you need innovation leaders who shepherd ideas through an innovation pipeline.

I don’t 100% buy into the Deming rule – let’s remember that in his world he was talking from the perspective of a tightly controlled factory floor, assembling products. I don’t challenge the idea that the system affects performance, or that we pay too much attention to people problems. However, anyone who has worked in an organisation that has experienced a profound change in personnel has seen the disruptive effects (positive and negative) that people can have. They influence things way more than 5%.

For most of us our work is inseparably connected with the people who operate within the system. You can change a single person and suddenly the rules of the game have changed and everyone else operates in a different context. The same system maybe, but in a very different context.

However, overall this is why one-size-fits-all transformation approaches don’t work, and for good reason. Transformation measures need to be carefully calibrated to the complexity of different areas of the organisation. More attention needs to paid to complex systems and how they fit within the overall organisational design.

Many managers though don’t want to go here – it’s too much like hard work. It’s genuinely easier to focus on ‘leaderism initiatives’ and management BS than it is to change the system.

I contend that the root cause of a lot of this is short-termism. Of Boards and Execs are often focussed on backward looking performance metrics rather than sustainable goals that may take years to realise. Larger scale change dies or thrives from the top. Accordingly the role of Boards in understanding the process of transformation, and the innovation culture it requires to thrive, cannot be underplayed.

Will our organisations ever focus on genuine system change? The Net Zero and wider sustainability agenda might bring with it a shift to longer term thinking – of looking at change over a period of years , or even decades. To bring about these sorts of changes requires whole system change.

Whole system change is based on whole systems thinking, that the parts of a system are all connected and, therefore, influence each other. Rewiring this requires a commitment that few will be willing to make.

We are living in times when we need radical solutions to big problems. 

The world is , as Seth Godin said , begging us to be remarkable.

We have an opportunity to be more different, more memorable and make more change than we ever have.

Who wants to win the race to mediocrity instead?

Photo by Susan Q Yin on Unsplash

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