{"id":585,"date":"2010-12-16T08:23:08","date_gmt":"2010-12-16T08:23:08","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=585"},"modified":"2010-12-16T08:23:08","modified_gmt":"2010-12-16T08:23:08","slug":"inborn-errors-of-management","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=585","title":{"rendered":"Inborn Errors of Management"},"content":{"rendered":"

\"\"<\/a>There is a group of diseases called “inborn errors of metabolism” which are caused by a faulty or missing piece of DNA – the blueprint of life that we inherit from our parents. DNA is the chemical\u00a0memory\u00a0that\u00a0stores\u00a0the\u00a0string of instructions for how to build every living organism – humans included. If just one\u00a0DNA instruction becomes damaged or missing then we\u00a0may\u00a0lose\u00a0the ability to make or to\u00a0remove\u00a0one specific chemical – and that can lead to a\u00a0deficiency or an excess of other chemicals –\u00a0which can then lead to dysfunction\u00a0– which can\u00a0then make us feel unwell – and can then limit both our quality and quantity of life.\u00a0\u00a0We are a biological system of interdependent parts. If an inborn error of metabolism is lethal it will\u00a0not\u00a0be passed on to our offspring because we don’t live long enough –\u00a0so the ones we see are the ones which\u00a0and not\u00a0lethal.\u00a0 We\u00a0treat the symptoms of an inborn error of metabolism by\u00a0artificially replacing the missing chemical – but the way to treat the cause is to repair, replace or remove\u00a0the faulty DNA.<\/p>\n

The same metaphor can be applied to\u00a0any social system. It too has a form of DNA\u00a0which is called\u00a0culture – the inherited set of knowledge, beliefs, attitudes and behaviours that the organisation uses to conduct itself in its day-to-day business of survival. These\u00a0patterns of behaviour are called memes – the\u00a0social equivalent to genes – and are passed on from generation to generation through language –\u00a0body language and symbolic language;\u00a0spoken words – stories, legends, myths, songs, poems and books – the cultural collective memory of the human bio-psycho-social system. All human organisations share a large number of common memes – just as we share a large number of common genes with other animals and plants and even bacteria. Despite this much larger common cultural\u00a0heritage – it is the differences\u00a0rather than the similarities that\u00a0we notice – and it is these differences\u00a0that spawn\u00a0the\u00a0cultural conflict that we observe at all levels of society.<\/p>\n

If,\u00a0by chance alone, an organisation\u00a0inherits a depleted set of\u00a0memes it will appear different to all the others\u00a0and it will tend to defend that difference rather than to change it. If an organisation has a meme defect, a cultural mutation that affects a management process, then we have the\u00a0organisational condition called an Inborn Error of Management – and so long as the mutation\u00a0is not lethal to the organisation it will tend to persist and be passed largely unnoticed from one generation of managers to the next!<\/p>\n

The NHS\u00a0was born in 1948 without a professional management arm, and\u00a0while it survived and grew initally, it became gradually apparent that the omisson of the professional management limb\u00a0was a problem; so in\u00a0the 1980’s,\u00a0following the Griffiths Report, a large dose professional management was grafted on and a dose of new management memes\u00a0were injected. These included finance, legal and human resource management\u00a0memes but one important meme was accidentally omitted – process engineering – the ability to design a process to meet a specific quality, time and cost specification.\u00a0\u00a0This omission was not noticed initially because the rapid development\u00a0of new medical technologies and new treatments\u00a0was delivering improvements that obscured the inborn error of management.\u00a0The NHS became\u00a0the\u00a0envy of many other countries – high quality healthcare available to all and free at the point of delivery.\u00a0\u00a0Population longevity improved, public expectation increased, demand for healthcare increased and inevitably the costs increased.\u00a0 In the 1990’s the growing pains of the burgeoning NHS led to a call for more funding, quoting other\u00a0countries as evidence, and at the turn of the New Millenium a ten year plan to pump billions of pounds per year\u00a0into the NHS was hatched.\u00a0\u00a0Unfortunately, the other healthcare services had inherited the same meme defect – so the\u00a0NHS\u00a0grew 40% bigger but no better – and the\u00a0evidence is now accumulatung that productivity (the ratio of output quality to input cost) has actally fallen by more than\u00a010% – there are more people doing more work but less well.\u00a0 The UK along with many other countries has\u00a0hit an economic brick wall\u00a0and\u00a0the money being sucked into the NHS\u00a0cannot increase any more – even though\u00a0we have created a\u00a0legacy of an increasing proportion of retired and elderly members of society to support.\u00a0<\/p>\n

The\u00a0meme defect that\u00a0the NHS inherited in 1948 and that was not corrected in the transplant operation \u00a01980’s\u00a0is now exerting it’s influence – the NHS has no capability for\u00a0process engineering – the theory, techniques, tools and training\u00a0required to design processes are not on the curriculum of either the NHS managers or the clinicians. The effect of this defect is that we can only treat the symptoms rather than the cause –\u00a0and we only have\u00a0blunt and ineffective instruments\u00a0such as a budget\u00a0restriction – the management equivalent\u00a0of a straight jacket – and\u00a0budget cuts – the management equivalent of a jar of leeches. To illustrate the scale of the effect\u00a0of this inborn error of management we only need to look at other organisations that do not appear to suffer from\u00a0the same condition – for example the electronics\u00a0manufacturing industry. The\u00a0almost unbelieveable increase in the\u00a0performance, quality and value\u00a0for money of modern electronics over the last decade (mobile phones, digital cameras, portable music players, laptop computers,\u00a0etc) is\u00a0because these industries have invested in developing both their\u00a0electrical and process engineering capabilities. The Law of the Jungle has weeded out\u00a0the\u00a0companies who did not\u00a0– they\u00a0have gone out of business or been absorbed\u00a0– but\u00a0publically funded service organisations like the NHS do not have this survival pressure – they are protected from it – and trying to simulate competition\u00a0with an artificial internal market and applying stick-and-carrot top-down target-driven management\u00a0is not a like-for-like replacement.\u00a0\u00a0\u00a0\u00a0<\/p>\n

The challenge\u00a0for the NHS is clear – if\u00a0we want to continue to enjoy\u00a0high quality health care, free at the point of delivery, and that we can afford\u00a0then\u00a0we will need to recognise and correct\u00a0our\u00a0inborn error of management. If\u00a0we ignore the symptoms, deny the diagnosis\u00a0and refuse to\u00a0take the medicine\u00a0then we will suffer\u00a0a painful and lingering decline – not lethal and\u00a0not enjoyable – and it is has a name:\u00a0purgatory.<\/p>\n

The good news is that the\u00a0treatment is neither expensive, nor unpleasant nor dangerous – process engineering is easy to learn, quick to apply, and delivers results almost immediately – and it can be\u00a0incorporated\u00a0into the organisational meme-pool quite quickly\u00a0by using the see-do-teach vector.\u00a0All we have to do is to own up to the symptoms, consider\u00a0the evidence,\u00a0accept the diagnosis, recognise the challenge and take\u00a0our medicine. The sooner the better!<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

There is a group of diseases called “inborn errors of metabolism” which are caused by a faulty or missing piece of DNA – the blueprint of life that we inherit from our parents. DNA is the chemical\u00a0memory\u00a0that\u00a0stores\u00a0the\u00a0string of instructions for how to build every living organism – humans included. If just one\u00a0DNA instruction becomes damaged … <\/p>\n

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