This morning, I went head to head with Labour MP John Healey on BBC Look North's news bulletin on the matter of NHS targets. Last night he admitted in a TV debate “We overdid the targets to start with” – sounds good? But unfortunately, Mr Healey qualified this and it all went square… “…but in my opinion, you’ve got to have something … if you want to guarantee patients the treatment”.
Unfortunately, John Healey has got it all wrong. Quite simply there is no good way for the NHS (or any other organisation for that matter!) to set a target, nor is there such a thing as a necessary or good target. No targets will help the patient, and they will almost certainly result in cheating, waste, duplication of effort and demoralized staff… ironically, right at a time when we need public services to be doing more with less!
For example, targets in the NHS represent a whole management factory of internal and external structures undertaking work specifying what needs to be done, as well as monitoring and reporting against targets and explaining any deviation from what has been specified – all this activity is waste which does nothing to improve the health of the nation, but devours resources and demoralises the front line staff delivering the service.
This is because when people know they are going to be judged against meeting of targets, they use their ingenuity and creativity to do whatever it takes to be seen to meet them (and so survive in the system). This can mean cheating, for example by distorting or misreporting data. Let’s look at a couple of examples in maternity services…
So for example, by the end of 2009 there was a government target for all prospective mums to be offered a choice in where their baby was to be born – with home being one of these choices. In reality this doesn’t happen where I live – I was offered a choice of 4 hospitals, and when I asked for a home birth, I was told I “probably wouldn’t be allowed one as they’re only for women who are really low risk” – although there was no medical reason to make me anything other than low risk. Similarly, other mums have reported spurious, emotive, non-evidence based reasons are given to strongly discourage them from home birth (“you’re brave”; “it’s your first birth” “you’re 7 days overdue” etc). When mums to be have dug their heels in, they’ll be lucky to get it - reported stats show that at my local hospital, the homebirth service was withdrawn 42 times between January 2008 & December 2009; midwives are not fully trained in, and are not fully confident in, supporting home deliveries; and there is only provision for one woman in the area to have a homebirth on any one day of the year!
However, if you were to ask the senior managers at the local NHS trusts, they’d probably tell you everyone gets the option to have a home birth. Someone’s not telling the truth, and I imagine it’s not the mums… to me it looks like the frontline staff have to offer a home birth service they’re unable to fulfil due to the way the local maternity care is currently run, so they do what they can to be seen to be offering homebirths.
Another example of cheating is with the target the NHS has to increase the percentage of women who have seen a midwife or a maternity healthcare professional for a health and social care assessment of needs, risks and choices by 12 completed weeks of pregnancy – digging a bit deeper, this seems to be borne out of a desire to get women seen as early as possible in pregnancy so they can access advice to give their babies the best start possible. A sensible target one might think… but what actually happens…?
As I knew I was pregnant ,I rang my local NHS midwives as I wanted to speak to a midwife (as per NHS website advice) ASAP to ensure I did everything I should to give my baby the best start I could. The midwife I spoke to told me they didn’t need to see me for a few weeks as they prefer not to see everyone for their booking appointment until about 10 weeks so they could exceed the government target of 12 weeks. She went on to explain that often babies die in the first few weeks (“it’s heartbreaking really” she said), so it was better to wait a bit longer. Hmmm – so they’d meet their target by seeing me within 12 weeks, and may be saving some time not seeing mums of babies that won’t make it until 12 weeks, but in reality, what they said was against the spirit of the target (see mums as early in pregnancy as you can) and left the patient feeling very upset & without the early advice the target was designed to ensure…
But the staff in the NHS aren’t bad people – they’re just stuck working in a very bad system. Knowing they’re cheating but feeling it is their only option must be awful – no wonder there’s high levels of staff absence, turnover & shortages!!
This is not modernization of the NHS – this is wholesale dismantling of the system we British hold so dear. Moreover, all public services are victims of the same target driven mentality. And what’s frightening is that not one of the political parties seems to understand the best way to make things better!
So what to do? The right thing to do is to abandon all the current targets. Every single one of them! But that doesn’t mean they shouldn’t measure anything – but we need to change the system, design the service against patient needs and measure what really matters to the public: patients, families and relatives! This will lead to a better quality service, systemic improvement of the NHS (rather than its systemic failure), better staff morale, and lower costs – it’s obvious to anyone that it’s in everyone’s interest to do things this way.
In the run up to the election, it’s very easy for politicians of all parties to make promises based on what they think the public want to hear. In the case of the NHS, though, we don’t just want empty promises and the creation of yet more targets and bureaucracy – what we need is a commitment to fundamentally overhaul how health services are designed, delivered and managed.
Politicians and NHS executives need to get close to the work being done on the front line so they can experience first hand the day to day problems encountered by both patients and their carers as well as the things that are going well and not so well.
Patients & frontline NHS staff are the very people that know how to fix the NHS – and the only way politicians can deliver an excellent and cost effective health care service that’s the envy of the rest of the world, is to harness that knowledge. But is anyone willing to listen…? This blogger remains sceptical…
Wednesday, 28 April 2010
Tuesday, 16 February 2010
What's happening in charity fundraising is what's happening in many call centres - and it needs to stop!
Last Sunday, the News of the World ran an exposé on the “shocking hard sell tactics” used by call centre company Pell & Bales to raise money for some of the UK's biggest charities.
The story told of lowly paid workers being put under massive pressure by commission driven bosses to meet their targets. The tactics reported by the News of the World as employed by Pell & Bales are unfortunately the same as those you’d find in a majority of the call centres you might deal with in your day to day lives: heavily scripted conversations, monitored constantly by managers giving “feedback” on how better the call centre worker might have handled the call in order to achieve the desired outcome (in the case of Pell & Bales getting someone’s bank details for a charity donation).
Maybe the charities concerned should look at a different way of working…. Perhaps using a call centre with a different approach, and look at paying a daily rate rather than £60 per donation. Whilst it needs to stack up financially for the charity and the call centre operator, it needs to be a sustainable approach in the long term for all concerned too.
As for the call centres, they should actually trust their staff to get on and do their work –Don’t get me wrong, I’m not having a go at Pell & Bales here – I only know what I read about them in the News of the World and what their former employees commented on the story. Rather, I’m having a pop at call centres in general!
This is because how staff do their work is decided by senior management that aren’t close enough to the front-line and team leaders monitor and control their staff, and measure individuals’ performance against arbitrary targets that have been derived from what the company needs to deliver in its financial plan (in the case of Pell & Bales, this is probably the number of £60 commissions it needs to get for each man day). But whilst that’s useful for the bean counters to know how profitable the work they do is, it really doesn’t help operationally at all.
Since call centre companies like Pell & Bales manage people in this way, they spend a lot of management time ensuring staff to meet their targets and follow scripts (the News of the World reports a former employee as saying “But one boss, who monitored nearly all the calls, said I should have asked her for money at least three times”). Unfortunately, since meeting targets is often outside of staff members’ control (after all, they can’t influence who they call next – for example, if they have no money, don’t support charities, if it’s convenient time to talk to them and so on), so achieving targets becomes more of a lottery. Moreover, constant monitoring and management pressure to perform better puts staff under stress, de-motivates them and has an adverse effect on staff turnover, sickness and absenteeism. A quick read of the comments at the bottom of the News of the World story gives a real insight into how call centre workers often feel - hating the work, listening to heartbreaking stories, staying because they need the money and so on.
To survive in such an environment, call centre workers need to do something – if they don’t leave the situation (which of course in the current economic climate isn’t so easy), they have to either fight (a dangerous strategy whereby you could lose your job)or submit to the system in which they’re operating. In submitting, however, the unfortunate worker (and their line managers or team leaders who are often subject to the same pressures) becomes desperate and often has to lie, cheat or bully. And when the client (in this case Cancer research) comes to listen in to calls “to ensure that our strict supporter care criteria are met at all times”, everything will be done differently. That’s not because the line managers or front line staff are bad people – they are simply operating in a very bad system. Precisely what the News of the World describes in its article.
As the News of the World says – this IS shocking! However, it is not unusual.
We need to see a bit more common sense in call centre management to improve this situation – for charity fundraising as well as every other sector: surely it’s better to trust people and allow them to take the time to just get on and do their jobs properly, allowing them to have the conversation that’s right for the person they’re talking to with the purpose of generating the best they can for the charity?
And if then it doesn’t stack up financially for the charities, then everyone involved should simply admit that an outbound call centre approach doesn’t work in this case, and revert to more cost-effective approaches. Surely that would be Better for Everyone?
The story told of lowly paid workers being put under massive pressure by commission driven bosses to meet their targets. The tactics reported by the News of the World as employed by Pell & Bales are unfortunately the same as those you’d find in a majority of the call centres you might deal with in your day to day lives: heavily scripted conversations, monitored constantly by managers giving “feedback” on how better the call centre worker might have handled the call in order to achieve the desired outcome (in the case of Pell & Bales getting someone’s bank details for a charity donation).
Maybe the charities concerned should look at a different way of working…. Perhaps using a call centre with a different approach, and look at paying a daily rate rather than £60 per donation. Whilst it needs to stack up financially for the charity and the call centre operator, it needs to be a sustainable approach in the long term for all concerned too.
As for the call centres, they should actually trust their staff to get on and do their work –Don’t get me wrong, I’m not having a go at Pell & Bales here – I only know what I read about them in the News of the World and what their former employees commented on the story. Rather, I’m having a pop at call centres in general!
This is because how staff do their work is decided by senior management that aren’t close enough to the front-line and team leaders monitor and control their staff, and measure individuals’ performance against arbitrary targets that have been derived from what the company needs to deliver in its financial plan (in the case of Pell & Bales, this is probably the number of £60 commissions it needs to get for each man day). But whilst that’s useful for the bean counters to know how profitable the work they do is, it really doesn’t help operationally at all.
Since call centre companies like Pell & Bales manage people in this way, they spend a lot of management time ensuring staff to meet their targets and follow scripts (the News of the World reports a former employee as saying “But one boss, who monitored nearly all the calls, said I should have asked her for money at least three times”). Unfortunately, since meeting targets is often outside of staff members’ control (after all, they can’t influence who they call next – for example, if they have no money, don’t support charities, if it’s convenient time to talk to them and so on), so achieving targets becomes more of a lottery. Moreover, constant monitoring and management pressure to perform better puts staff under stress, de-motivates them and has an adverse effect on staff turnover, sickness and absenteeism. A quick read of the comments at the bottom of the News of the World story gives a real insight into how call centre workers often feel - hating the work, listening to heartbreaking stories, staying because they need the money and so on.
To survive in such an environment, call centre workers need to do something – if they don’t leave the situation (which of course in the current economic climate isn’t so easy), they have to either fight (a dangerous strategy whereby you could lose your job)or submit to the system in which they’re operating. In submitting, however, the unfortunate worker (and their line managers or team leaders who are often subject to the same pressures) becomes desperate and often has to lie, cheat or bully. And when the client (in this case Cancer research) comes to listen in to calls “to ensure that our strict supporter care criteria are met at all times”, everything will be done differently. That’s not because the line managers or front line staff are bad people – they are simply operating in a very bad system. Precisely what the News of the World describes in its article.
As the News of the World says – this IS shocking! However, it is not unusual.
We need to see a bit more common sense in call centre management to improve this situation – for charity fundraising as well as every other sector: surely it’s better to trust people and allow them to take the time to just get on and do their jobs properly, allowing them to have the conversation that’s right for the person they’re talking to with the purpose of generating the best they can for the charity?
And if then it doesn’t stack up financially for the charities, then everyone involved should simply admit that an outbound call centre approach doesn’t work in this case, and revert to more cost-effective approaches. Surely that would be Better for Everyone?
Monday, 8 February 2010
Toyota – once hailed as the right way to work – but is it any more….?
Oh dear – it’s all gone square in Toyota… The company is currently recalling millions of cars due to concerns about a sticking accelerator pedal. A bit of digging behind the scenes of this story, and I’m reaching the conclusion that Toyota have foolishly changed their management focus from quality to growth and are now paying the price… a predicted $2 billion, not withstanding the cost to the Toyota brand!!!
In 2002, the president of Toyota (Fujio Cho) declared Toyota’s intention to be the world’s No. 1 carmaker by 2010 with a 15% share of the global car market.
In striving for this vision, they lost everything that they stood for as a business, and became the same as everyone else in the industry.
Unfortunately, Toyota forgot what it was good at (being the best through its work culture) and focused on growth (just like everyone else) – then suddenly, just like any other car manufacturer, they found themselves looking for ways to cut costs – including a move to common components in multiple vehicle models and outsourcing to and sharing global manufacturing and production.
Toyota always bought all its parts from long term partners - a small group of Japanese suppliers. However, like almost all car manufacturers, Toyota more recently has outsourced much of its manufacturing and production. The recalled accelerator pedals were produced a factory in the Czech Republic - pedals made by Toyota’s original manufacturer in Japan have not had any problems at all.
What is particularly worrying is that the issues caused by the change in direction were raised in 2008 by former Toyota president, Katsuaki Watanabe (now vice chairman), in his speech to Japan’s National Press Club, when he is quoted as stating that Toyota was becoming infected with “big company disease” – arrogance and complacency due to its own success. According to the Associated Press, Mr. Watanabe commented, “The fact that Toyota is growing globally suddenly shouldn’t be used as an excuse [for problems].”
It’s obvious to anyone with eyes that this is all about the basics in management thinking in Toyota. Quite simply, Toyota became the best because of how the company worked – their work culture, operating model and management focus. They had no problems until that focus changed to ambitious growth.
The jungle drums say Toyota once again is being led by someone committed to the traditional Toyota Production System model concepts and who will focus on taking the company back to the fundamentals – that can only be good news for Toyota… even if it does cost them $2 billion to work out that focusing on quality takes you where you want to be, rather then chasing the dollars….
In 2002, the president of Toyota (Fujio Cho) declared Toyota’s intention to be the world’s No. 1 carmaker by 2010 with a 15% share of the global car market.
In striving for this vision, they lost everything that they stood for as a business, and became the same as everyone else in the industry.
Unfortunately, Toyota forgot what it was good at (being the best through its work culture) and focused on growth (just like everyone else) – then suddenly, just like any other car manufacturer, they found themselves looking for ways to cut costs – including a move to common components in multiple vehicle models and outsourcing to and sharing global manufacturing and production.
Toyota always bought all its parts from long term partners - a small group of Japanese suppliers. However, like almost all car manufacturers, Toyota more recently has outsourced much of its manufacturing and production. The recalled accelerator pedals were produced a factory in the Czech Republic - pedals made by Toyota’s original manufacturer in Japan have not had any problems at all.
What is particularly worrying is that the issues caused by the change in direction were raised in 2008 by former Toyota president, Katsuaki Watanabe (now vice chairman), in his speech to Japan’s National Press Club, when he is quoted as stating that Toyota was becoming infected with “big company disease” – arrogance and complacency due to its own success. According to the Associated Press, Mr. Watanabe commented, “The fact that Toyota is growing globally suddenly shouldn’t be used as an excuse [for problems].”
It’s obvious to anyone with eyes that this is all about the basics in management thinking in Toyota. Quite simply, Toyota became the best because of how the company worked – their work culture, operating model and management focus. They had no problems until that focus changed to ambitious growth.
The jungle drums say Toyota once again is being led by someone committed to the traditional Toyota Production System model concepts and who will focus on taking the company back to the fundamentals – that can only be good news for Toyota… even if it does cost them $2 billion to work out that focusing on quality takes you where you want to be, rather then chasing the dollars….
Tuesday, 2 February 2010
Doing more with less - meeting the management challenge of 2010
This week, FT columnist Stefan Stern wrote an interesting piece entitled “Your task for today is doing more with less”.
Predicting “more with less” as the new management mantra for Stern cites worrying trends in recent research from both Roffey Park (the number of managers that felt performance management was handled badly in their organisation had doubled since last year) and Chartered Institute of Personnel & Development (reported UK job satisfaction at record lows).
Ouch!
The upshot of the article is that the management challenge of these times is for business leaders to get their teams to work smarter & harder by delivering efficiency savings and increased productivity. Stern has really hit the nail on the head with this, which applies equally to leaders in both public, private & third sector organisations– but unfortunately the article failed to offer the answer of how this might be achieved…
Ironically, Stern did allude to the reality that rather than bashing fewer employees to do more of everything they do, doing “more with less” may simply mean taking a proper look at what organisations do, and choosing what to stop doing, and what to do more of.
But in order to do that, your typical business leader will really need to change how they think – they need to stop focusing on the necessity to reduce costs, instead seeking to look at their organisations as systems.
Firstly, and without judgement, leaders need to work with front line staff to understand what they do now and why they do things that way: consider their purpose (what do they exist to do as an organisation?); look at the efficiency & effectiveness of their processes from their customers point of view; and things that get in the way (e.g. traditional performance management, legislation, interpretation and attempts to prevent potential problems).
Only when they have a clear picture of their organisation as a system in this way, can leaders see what needs to change in their organisations – what they can stop doing to improve the work they do to enable them to do more with less.
This isn’t easy though, and it’s certainly not a quick fix – it involves leaders’ commitment and understanding to make a successful change. They need to change the principles they follow in terms of, for example, customers’ experience, job design and how they’ll use measures to continue to improve the work they do in the longer term.
In 2010, these can no longer be leadership choices – they are fundamental to survival of our economy. They are leadership necessities… let’s hope government and business leaders work this out before it’s too late… unfortunately this blogger isn’t too optimistic…
Predicting “more with less” as the new management mantra for Stern cites worrying trends in recent research from both Roffey Park (the number of managers that felt performance management was handled badly in their organisation had doubled since last year) and Chartered Institute of Personnel & Development (reported UK job satisfaction at record lows).
Ouch!
The upshot of the article is that the management challenge of these times is for business leaders to get their teams to work smarter & harder by delivering efficiency savings and increased productivity. Stern has really hit the nail on the head with this, which applies equally to leaders in both public, private & third sector organisations– but unfortunately the article failed to offer the answer of how this might be achieved…
Ironically, Stern did allude to the reality that rather than bashing fewer employees to do more of everything they do, doing “more with less” may simply mean taking a proper look at what organisations do, and choosing what to stop doing, and what to do more of.
But in order to do that, your typical business leader will really need to change how they think – they need to stop focusing on the necessity to reduce costs, instead seeking to look at their organisations as systems.
Firstly, and without judgement, leaders need to work with front line staff to understand what they do now and why they do things that way: consider their purpose (what do they exist to do as an organisation?); look at the efficiency & effectiveness of their processes from their customers point of view; and things that get in the way (e.g. traditional performance management, legislation, interpretation and attempts to prevent potential problems).
Only when they have a clear picture of their organisation as a system in this way, can leaders see what needs to change in their organisations – what they can stop doing to improve the work they do to enable them to do more with less.
This isn’t easy though, and it’s certainly not a quick fix – it involves leaders’ commitment and understanding to make a successful change. They need to change the principles they follow in terms of, for example, customers’ experience, job design and how they’ll use measures to continue to improve the work they do in the longer term.
In 2010, these can no longer be leadership choices – they are fundamental to survival of our economy. They are leadership necessities… let’s hope government and business leaders work this out before it’s too late… unfortunately this blogger isn’t too optimistic…
Saturday, 23 January 2010
Mother knows best – a bizarre tale of variation…
As those of you who know me are already aware, I’m now just over 28 weeks pregnant! This is a brand new and exciting experience for me, and has exposed me to a whole raft of strange stories I can share with you all, primarily around the bizarre way I’ve seen management practices in the NHS seek to industrialise this very natural process.
In this blog, I’m going to look at due dates – how they’re calculated and managed…. For those of you not familiar, when a woman finds out she’s pregnant, the due date (the date we’d expect baby to arrive) is estimated using a calculation which is roughly along the lines of 40 weeks (280 days) after their last period.
It doesn’t take a world renowned obstetrician to explain that there are several factors that might influence the accuracy of this date which is known as the estimated date of delivery or EDD, for example, women’s menstrual cycles vary, dates may be inaccurate and also the length of gestation (the length of time it take an embryo to develop into a baby ready to be born).
So to get round this “problem”, a lot of women are sent for a dating scan when they think they are around 12 weeks pregnant to literally “date” the pregnancy. Now this ultrasound EDD, coupled with the original EDD, and monitoring at different stages during pregnancy does seem to give a good indication of timely development of the baby at any moment in time. However, this amateur medic has noticed that all children vary in their development, with growth spurts and plateaus, and understands this variation also applies in babies before they are born too.
This variation isn’t some wild phenomenon that just applies to pregnancy and childbirth… Imagine you catch the bus to work… the timetable says it leaves your stop at 8am. Even if it comes on time, you’re not pleased – because you’ve probably learned that although the 8 o’clock bus always gets you to work in time, it can arrive any time between ten to and ten past eight, so to guarantee you catch it, you need to be at the stop by 7.50am, meaning when it’s on time, you’ve still had to wait 10 minutes, and if it’s late, you’re getting pretty grumpy because you’ve been standing in all weathers for 20 minutes! But you know what to expect unless something out of the ordinary happens.
I drive to work – even if I set off at exactly the same time every day, it can take me between 45 minutes and 70 minutes to arrive at the car park at work. There are many things that influence the time it takes to vary so much – everything from if it’s sunny or raining (so if people walk, get the bus or drive), roadworks or accidents en route, whether I hit the many sets of traffic lights on red or green, through to the time other drivers set off that day. However, earlier this month it took me 3 ½ hours to get to work – not because of any of these “common causes”, but because of something very unusual – really bad snow and ice had closed many routes “over the tops” to Bradford, and the main roads were still pretty treacherous, resulting in a huge volume of traffic and massive delays for everyone – a “special cause”.
So going back to the birth of babies – this is precisely what is happening with due dates - only 5% of babies arrive on their due date, with typically 95% of babies being born between approximately 265 and 300 days, with the average roughly around the EDD or 280 days. So in reality, it may be smarter to suggest a baby might be expected in a particular month, rather than on a particular date, and only be concerned if a baby arrives before 265 days or after 300 days….
I wish someone would explain variation to some of the maternity service providers – then they might stop treating women whose pregnancies go "post term" (beyond their EDD) as special cases requiring medical intervention.
Once a mum gets to her EDD, the maternity services start paying attention to her – they want to get her monitored on a daily basis (often above and beyond government guidelines), and want to get her booked in for an induction whether or not there is any real medical reason. I’ve heard of a number of cases where mothers have been bullied and pressured by midwives and obstetricians using emotive language rather than evidence based information as they go beyond the EDD. I know of people that have been threatened with still born babies, have been offered mental health services and had implications that made them feel like social services might be involved further down the line because they’d prefer to adopt a “wait and see” approach, providing everything was ok with their baby.
Ironically, this whole exercise causes stress for the woman concerned, which in itself can delay labour! But more worryingly, the induction of a baby that’s simply not ready to be born would result in birthing an immature baby and can mean further medical intervention and an increased possibility of a caesarian being required. It’s obvious that this is no good for mum and baby. But there is also a real, adverse impact on the NHS in terms of the additional costs associated with premature baby care, surgery and after care for mum.
So why, you might ask, is the NHS doing something that on the face of it to the lay man seems so crazy! The straight answer is that I’m not sure – there seem to be a number of issues at play which might include a fear of litigation (so everyone is treated as a special case rather than those that need it, “just in case”); how the PCTs are funded for maternity services; or meeting the dreaded targets.
However, whatever the problem, something needs to be done to bring our maternity services back to basics - delivering their true purpose, not covering their backs and following policies and guidelines. But the NHS really needs to take steps to understand & accept the common causes of variation in arrival dates, and the difference between them and special situations that actually do require their help and intervention!
Unfortunately, this blogger knows that won’t happen before her baby arrives “some time in April”…
In this blog, I’m going to look at due dates – how they’re calculated and managed…. For those of you not familiar, when a woman finds out she’s pregnant, the due date (the date we’d expect baby to arrive) is estimated using a calculation which is roughly along the lines of 40 weeks (280 days) after their last period.
It doesn’t take a world renowned obstetrician to explain that there are several factors that might influence the accuracy of this date which is known as the estimated date of delivery or EDD, for example, women’s menstrual cycles vary, dates may be inaccurate and also the length of gestation (the length of time it take an embryo to develop into a baby ready to be born).
So to get round this “problem”, a lot of women are sent for a dating scan when they think they are around 12 weeks pregnant to literally “date” the pregnancy. Now this ultrasound EDD, coupled with the original EDD, and monitoring at different stages during pregnancy does seem to give a good indication of timely development of the baby at any moment in time. However, this amateur medic has noticed that all children vary in their development, with growth spurts and plateaus, and understands this variation also applies in babies before they are born too.
This variation isn’t some wild phenomenon that just applies to pregnancy and childbirth… Imagine you catch the bus to work… the timetable says it leaves your stop at 8am. Even if it comes on time, you’re not pleased – because you’ve probably learned that although the 8 o’clock bus always gets you to work in time, it can arrive any time between ten to and ten past eight, so to guarantee you catch it, you need to be at the stop by 7.50am, meaning when it’s on time, you’ve still had to wait 10 minutes, and if it’s late, you’re getting pretty grumpy because you’ve been standing in all weathers for 20 minutes! But you know what to expect unless something out of the ordinary happens.
I drive to work – even if I set off at exactly the same time every day, it can take me between 45 minutes and 70 minutes to arrive at the car park at work. There are many things that influence the time it takes to vary so much – everything from if it’s sunny or raining (so if people walk, get the bus or drive), roadworks or accidents en route, whether I hit the many sets of traffic lights on red or green, through to the time other drivers set off that day. However, earlier this month it took me 3 ½ hours to get to work – not because of any of these “common causes”, but because of something very unusual – really bad snow and ice had closed many routes “over the tops” to Bradford, and the main roads were still pretty treacherous, resulting in a huge volume of traffic and massive delays for everyone – a “special cause”.
So going back to the birth of babies – this is precisely what is happening with due dates - only 5% of babies arrive on their due date, with typically 95% of babies being born between approximately 265 and 300 days, with the average roughly around the EDD or 280 days. So in reality, it may be smarter to suggest a baby might be expected in a particular month, rather than on a particular date, and only be concerned if a baby arrives before 265 days or after 300 days….
I wish someone would explain variation to some of the maternity service providers – then they might stop treating women whose pregnancies go "post term" (beyond their EDD) as special cases requiring medical intervention.
Once a mum gets to her EDD, the maternity services start paying attention to her – they want to get her monitored on a daily basis (often above and beyond government guidelines), and want to get her booked in for an induction whether or not there is any real medical reason. I’ve heard of a number of cases where mothers have been bullied and pressured by midwives and obstetricians using emotive language rather than evidence based information as they go beyond the EDD. I know of people that have been threatened with still born babies, have been offered mental health services and had implications that made them feel like social services might be involved further down the line because they’d prefer to adopt a “wait and see” approach, providing everything was ok with their baby.
Ironically, this whole exercise causes stress for the woman concerned, which in itself can delay labour! But more worryingly, the induction of a baby that’s simply not ready to be born would result in birthing an immature baby and can mean further medical intervention and an increased possibility of a caesarian being required. It’s obvious that this is no good for mum and baby. But there is also a real, adverse impact on the NHS in terms of the additional costs associated with premature baby care, surgery and after care for mum.
So why, you might ask, is the NHS doing something that on the face of it to the lay man seems so crazy! The straight answer is that I’m not sure – there seem to be a number of issues at play which might include a fear of litigation (so everyone is treated as a special case rather than those that need it, “just in case”); how the PCTs are funded for maternity services; or meeting the dreaded targets.
However, whatever the problem, something needs to be done to bring our maternity services back to basics - delivering their true purpose, not covering their backs and following policies and guidelines. But the NHS really needs to take steps to understand & accept the common causes of variation in arrival dates, and the difference between them and special situations that actually do require their help and intervention!
Unfortunately, this blogger knows that won’t happen before her baby arrives “some time in April”…
Thursday, 14 January 2010
Orange cuts 300 call centre jobs in order to "improve, grow & evolve the company"
Yesterday, mobile phone giant
OK – so let me translate – in order to cut costs (perhaps something to do with their impending merger with T Mobile who operate their call centres overseas??),
But is that really the smartest thing to do…? Many of the internet sites that published this story had comments posted that not only sympathised with the displaced workers, but also were critical of
I’m not advocating that
As I’ve said before, this is possible – not through some magical, mystical approach, but through applying a bit of common sense! Instead of focusing on productivity, the management at Orange need to measure what matters to their customers: focus on quality, and trusting and empowering their staff to do what customers ask them to and taking the time to do it right first time, every time. Then their efficiency will be better as a direct consequence.
Delivering a better quality service means lower operating costs, lower prices, improved market share and company growth – which sounds a bit to me like what
So come on
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