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October 22, 2005

Stupid, Stupid.

I know I criticize the National Health Service a lot, regarding it as producer driven and a bureaucratic nightmare. But I’m also willing to admit that the management itself can be guilty of the most crass stupidity.

The head of an accident and emergency department has been suspended after attacking the "shocking and inexcusable" conditions at his hospital.

What did he do? Invite the local TV station round to film the filth?

Paul Lewis wrote to his managers describing a "nightmare" weekend in his overcrowded department at Grantham Hospital, Lincs, where patients were left on trolleys in corridors because of a shortage of beds.

He wrote to his managers telling them the truth? Stupid, stupid bastards. He’s head of the department and is therefore at minimum junior management if not middle. He tells senior management that there is a problem and he gets suspended? Fire the entire bloody board at once! How are they ever to know there is indeed a problem, one that they need to solve, if they won’t listen to what line management tell them? Do they think they can manage in some hermetic bubble where they issue instructions according to plan and not look at the feedback from the real world?

They simply don’t seem to understand what management is. Yes, planning is nice but the most important thing is variance. Where is reality deviating from the plan? (Or vice versa, of course.) To measure that you need to look out at what is actually happening and that means actually listening to what people are telling you. Jeez, it’s so damn simple.

If the 18 year old Lithuanian girl who cleans the toilets comes to the senior manager and points out that there is not enough paper to restock the cubicles the correct reaction is "Thank you for the information, very well done for bringing it to my attention" followed by a quick trip to those very toilets, the store cupboard and then an interesting and vehement discussion with the purchasing manager. Plus, if necessary, a quick trip to the supermarket to buy in a few packs.

That’s what managers are supposed to do. Take care of the problems so that people can get on with what they are there for whether it be scrubbing out the U-bend, treating patients or buying toilet roll.

And if these fools in Grantham don’t understand this simple fact of life then fire them and get some people in who do. The guy running the local Micky D’s probably has a better idea of what management is.

October 22, 2005 in Health Care | Permalink


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You have a charmingly naive view of management, Tim.
The purpose of management is not not manage, or to solve problems. It's to pretend that everything is running smoothly anyway. Why do you think PR and spin are so important? Management is about manipulating image, not reality. Protherough and Pick's book, Managing Britannia, is superb on this.

Tim adds: Maybe it’s because I’ve spent my working life managing companies that I own. Managers do the crap so that everyone else can get on with things. The only other important job is to keep an eye open for someone who can do that job better than you can and when you find them, promote them.

Posted by: chris | Oct 22, 2005 11:59:39 AM

It's very probable that the manager at McD has a much better grasp of management. First of all, (s)he's probably worked his/her way up from the floor which gives him/her an insight in the problems that need to be solved. Second, McD give their managers good courses. Third, there's a lot of documentation at McD's about what to do in various situation. Of course, documentation can be misapplied, but it's more often good than bad.
And why are you surprised? Isn't this part of what von Mises told us?

Posted by: Anders Starmark | Oct 22, 2005 1:26:59 PM

Where is reality deviating from the plan?

You silly man! They simply plan for reality not to deviate, and then they get very highly respected people with degrees from good schools to sign off on the plan. It's as simple as that.

Posted by: Professor Froward | Oct 23, 2005 12:23:51 AM

Managers unable to manage are not the sole preserve of the state. You should try working for a monolithic, private sector company, we have just as many jobsworths unable to perform.

That being said, the state system does tend to encourage that sort of behaviour far more than the private sector.


Posted by: Remittance Man | Oct 24, 2005 7:09:06 AM