Phil's blog

This is relevant to leadership and customer issues, so I’ll post this in both blogs.

From BBC News today comes another example of how people cheat when they have to work in a target-based performance management system – even with the best intentions and even the most senior people (what, you only expect call centre agents to cheat their targets? Target-based systems distort everything and most people’s behaviour).

Again, this one is from the National Health Service, and follows on from sporadic stories of ambulances having to wait outside hospitals with patients in the back (because the Accident and Emergency ‘waiting time limit’ for patients, imposed by central government, is measured from when they come in through the door, and the hospital would have broken its limit and been penalised if the patients waited inside the hospital for treatment, so they were kept in ambulances).

This isn’t evidence of pernicious people. It’s brilliant, dedicated people pushed into ludicrous behaviour by top-down target-setting. Top-down targets distort. Check out any of the lean service analysts and consultants to see how flawed the whole thing is. Anyway, here’s the latest example of what bad targets do to good people – and the terrible damage it does to the reputation of a much-loved institution:

FROM THE BBC

Patient waiting lists ‘manipulated’
Last Updated: Saturday, 07 April 2007, 12:28 GMT

A senior cancer specialist has admitted giving patients unnecessary treatments to manipulate hospital waiting lists.

Chris Hamilton, consultant clinical oncologist at Hull’s Princess Royal Hospital, told the BBC the problem was a government requirement that all treatment began within 31 days of diagnosis.

He says it means some low-risk patients are being treated before more urgent cases.

Mr Hamilton told the BBC he had given some prostate cancer patients hormone therapy to move them down the waiting list.

He said: “You’re caught in a bind. Either you give them unnecessary treatment with hormones and reclassify them or you put them to the front of the queue where they shouldn’t really be.”

He added that he knew other hospitals were carrying out a similar practice and he had informed national cancer director Mike Richards.

The Prostate Cancer Charity condemned Mr Hamilton’s claims saying it was “deeply unethical” to give patients treatment they did not need.

Dr Chris Hiley, head of policy and research, said: “It would be totally unacceptable if hormone treatment were being prescribed for men with prostate cancer simply in order to meet treatment target times – when it is not required to treat their cancer.

“It has nothing to do with patient centred care or good medicine.

“When men are diagnosed with prostate cancer, they need personal support and timely treatment. Providing the wrong treatment to meet NHS targets shows no regard for what patients need – the right treatment given at the right time with care and respect.”

There’s a nice example from Marion Janner in her latest post over on the Bright Blog of how a bit of imagination and improvisation can improve the customer experience no end – in this case by overcoming boredom and lethargy, a constant problem in any institutional setting, with the spontaneous help of a paper plate adapted as an indoor Frisbee to lift the spirits of a group of patients in an acute mental health ward.

Here’s what Marion wrote:

“Two of the things that impressed me most were improvisations. One of the dynamic HCAs who is an activity co-ordinator…described how there was a rather lethargic atmosphere on the ward one day. Spontaneously she found a paper plate and suddenly there was an animated game of indoor Frisbee!

And a ward with a kitchen which has no oven (excessively risk averse planning, presumably) hasn’t stopped the creative ward manager from regular cooking sessions for patients. They use a bread-making machine, make microwave and freezer cakes and harness the relaxed sociable potential of communal meals there.”

This use of improvisation and initiative isn’t trivial: it’s vital. And it’s often cost-free. Read Marion’s latest post to see how the culture of improvisation she describes is an integral part of the overall culture of extremely good customer care the hospital she was visiting operates, and how it centres on allowing frontline people to take the initiative to enrich people’s lives.

Leaving customers sitting around bored is probably one of the worst things you can do. It’s exactly what Easyjet did to me a couple of weeks ago: crammed all of us into a small departure lounge with stairs leading to no plane (we could all see there was no plane, but they crammed us into the tiny departure gate area nonetheless), many people having to stand because there weren’t enough seats, and the gate staff walking backwards and forwards among us doing important things with tickets, doors, phones, and other procedures without for a moment thinking their job might include talking to the customers and giving us a clue as to what was going on – or even a clue that they noticed we were there. We just sat – or stood – there for half an hour till the plane arrived and we were told to board, with no explanation or apology.

At Southwest Airlines the gate attendants have a stock of pipe cleaners under the desk. If a plane is delayed for any reason, rather than keeping people waiting with no messages or interaction from the gate staff whatsoever, they take out the pipe cleaners, hand them around and offer a prize for the best pipe cleaner figure customers can come up with. Maybe you don’t want to play: but it’s better than being ignored.