Doing something badly doesn’t necessarily mean the solution was wrong

The coal face. The front line. The people that do the actual work.

These are the people who understand how an organisation delivers their product or service.

Yet it’s management who have the responsibility for improving a product or service. How well does a manager understand the work of their team or their department completes? More often than not the answer is ‘not very well.

And so you ask people who don’t understand the work very well to be responsible for improving it. Or perhaps you bring in internal or external specialists to effect change, but the point remains the same – they don’t understand the work either.

Why is it that the people who understand the work the best, who are essential for the success of any improvement are the ones least involved?

We’ve recently heard that the failed NHS National Programme for IT has cost taxpayers £10.1bn. The Government said it was no longer appropriate for a centralised authority to make decisions on behalf of local organisations. But was that really the problem? I would have thought that a national programme for a national service like the NHS was completely appropriate.

As a result of that misguided notion that somehow central control was the root of all failure, the Government has handed over control over IT decision making to local organisations. Now we’ll have even more waste, it just won’t be centralised. We’ll have different solutions being created to solve the same problems because believe it or not, clinicians in Newcastle have the same wants and needs as clinicians in Brighton. Will this new approach, where decision making is in the hands of local authorities and trusts, resolve the issue?

No. The real problem was the central programmes complete and utter failure to engage with the people at the coal face. They failed to understand what patients, doctors, nurses and consultants needed to ensure that the system was improved. Every day, these people deal with an imperfect system. They know where they waste time and effort on a bad process and where improvements can be made to the system.

There were other reasons why the NHS programme failed but the failure to engage the coal face is certainly one of the major root causes. I see the same issues in improvement programmes that have failed to deliver the expected benefits in both the public and private sectors.

So how do you make sure that the front line is actively participating in an improvement programme?

1. Seek front line colleagues views/opinions/thoughts/feedback right at the beginning. 

Don’t summon a group of front line staff to a meeting room and grill them. Go and watch them do their job. Chat with them whilst you watch. Ask them why they do what they do and ask them what they would change if they could.

2. Involve front line colleagues in Value Stream Mapping workshops.

Ensure that a cross-section of front line staff participates in workshops. They can validate that you’ve understood the process and they can help you design an improved one.

3. Invite front line colleagues to be a part of the implementation of improvements.

People will be more committed to a change and making it sustainable if it came from them and their peers, rather than some internal or external ‘experts’ or senior managers.

Next time you commence an improvement programme, engage the front line as much as possible. This is where change happens.