In this post I continue the conversation that I started in the last post. I am almost never at a loss to write as the words write themselves. And indeed I have just deleted forty minutes of writing. Why? It occurs to me that they add nothing to what Robert Francis QC says. Before I share his words with you let me set the scene, the context, such that his words have significance for you.
What occurred, how were the customers – the patients – treated?
“The evidence gathered by the Inquiry shows clearly that for many patients the most basic elements of care were neglected. Calls for help to use the bathroom were ignored and patients were left lying in soiled sheeting and sitting on commodes for hours, often feeling ashamed and afraid. Patients were left unwashed, at times for up to a month. Food and drinks were left out of the reach of patients and many were forced to rely on family members for help with feeding. Staff failed to make basic observations and pain relief was provided late or in some cases not at all. Patients were too often discharged before it was appropriate, only to have to be re-admitted shortly afterwards. The standards of hygiene were at times awful, with families forced to remove used bandages and dressings from public areas and clean toilets themselves for fear of catching infections”
What is the profound truth that Robert Francis QC unconcealed and discloses about us and for us?
This is the ugly truth. What drives organisational policies and practices is the obsession with making the numbers. And for as long as our companies, our organisations, our institutions, our political system is focussed on making the numbers all this talk about customer focus, the customer experience, citizen charters, the patient experience is bullshit. Or as Werner Erhard would say it is simply “icing on a mud pie”. You may prefer “putting lipstick on a pig”. An authentic customer orientation requires one to stop with the icing, with the lipstick. And deal with the mud pie, the pig.
Now is the time for me to share with you the profound truth that Robert Francis QC has unconcealed and disclosed as a result of his investigation and report:
“People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.“
What else does Robert Francis QC say that is worth listening to? When I say listening to, I mean really listening to – the kind of listening that shakes and rattles our bones.
“I heard so many stories of shocking care. These patients were not simply numbers they were husbands, wives, sons, daughters, fathers, mothers, grandparents. They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.”
By now your internal dialogue will have kicked in. And if you go by the standard rules then you are most likely pointing the finger at the nurses and doctors. That is to say that you are pointing the finger at the people who actually do the work. This is fashionable – it is the ‘rogue agent’, the ‘rotten apple in the barrel’ reasoning/defence. Only those who are not versed in the ways of systems thinking and modeling jump to this conclusion. And the politicians. When I say politicians I point at the Tops wherever they are and in whichever organisation they reside. What does Robert Francis QC say?
“It is now clear that some staff did express concern about the standard of care being provided to patients. The tragedy was that they were ignored and worse still others were discouraged from speaking out.”
When a system does not generate the kind of behaviour that we want it to generate then who should we hold responsible?
I say that there is no such thing as a dysfunctional system. Every system works perfectly. Every system is perfectly functional. A system’s behaviour is determined by its structure and its rules. Hence, the responsibility and accountability for the performance – that which shows up in and as a result of the system – ALWAYS lies with the designers: the people who get to say what the pieces are, who the players are, what the roles are, and what the rules are. These people almost always sit either outside the system ‘pulling the strings’ and/or at the top of the system. What does Robert Francis QC say?
“A number of staff and managers at the hospital, rather than reflecting on their role and responsibility, have attempted to minimise the significance of the Healthcare Commission’s findings. The evidence gathered by this Inquiry means there can no longer be any excuses for denying the scale of failure. If anything, it is greater than has been revealed to date. The deficiencies at the Trust were systemic, deep-rooted and too fundamental to brush off as isolated incidents.”
If you want to excel at the game of service, customer experience, of customer loyalty then I say listen to these word such that they shake your very being and thus transform you:
“People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.”
Let me put it bluntly. If you do not love people, yes LOVE people, LOVE being of service, LOVE contributing to creating a world that works for all, then you are wasting your time on customer service, on customer experience, on customer focus, on customer-centricity. Go and do something else. Go and do something that you can be great at. At the Customer thing you will be mediocre at best: at the level of the individual, the team, the department, the organisation as a whole. Go and play the least cost route: Ryanair. Or, go and play the great product route: Apple, Dyson…