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PRACTICE DEVELOPMENT IN HEALTH CARE
4(4): 169-170 (2005) DOI: 10.1002/pdh.22
Editorial
Improving performance and
outcomes
I guess that I, along with many other experienced organizational development consultants,
have wondered how one health care organization can vary so much in terms of outcome and
impact from another even though they work in
similar localities, have similar challenges and
operate within similar budgets. Indeed much
development time, research effort and modernization activity has been focused on evening up
these very differences. Often this effort has centred on aspects of financial management, and
getting the structures and processes right. The
whole process re-engineering movement is a
classic example of this. In a search for efficiency,
communication is systematized and formally cascaded, and role boundaries are clearly defined
and formularized (e.g. Agenda for Change). But
where is the evidence that this works and how
do we know this is the right thing to do?
So it was with real interest I read a recent
and well-researched report from the Work
Foundation which set about explaining why
the UK has grown some of the most innovative
and successful companies in the world, and
also some of its least inspiring and unambitious. Cracking the Performance Code (Work
Foundation, 2005) looked in detail at nearly
3000 UK firms from all sectors of the economy
and analysed their activities in detail.
Following this analysis the research team
arrived at some unanticipated conclusions. In
particular, they identified five core areas of
strategic interdependency that are critical to
understanding high performing organizations.
These five intangible factors are structure,
process, leadership, communication, and culture and employee relations. At first glance
some of those do not look particularly surprisCopyright © 2005 John Wiley & Sons, Ltd.
ing to the health sector until you reflect in
detail on some of the organizational behaviours
we are seeing occurring (and being rewarded)
more frequently in some organizations.
For example, the report urges us not to get
hung up on structure. ‘It is more a function of
size where a business is located, its history and
traditions. Structure does not drive performance but enables it. It is a means to an end
rather than an end in itself.’ (Work Foundation
2005: 8). Perhaps the current hours being spent
debating structures may be better spent on discussions about patient outcomes and our end
product, namely health services.
On process the report notes, ‘Keep processes simple and allow a high degree of informality. Combined with continued dialogue, these
will allow faster decision-making.’ (ibid). In
this case simple does not mean simplistic, but
this is not a conversation I hear organizations
engaging in. This emphasis is also echoed in
the approach to leadership and communication, where the report emphasizes visibility,
sharing, and accessibility. It challenges the
dominant thinking of the importance of
visionary leadership models so promoted by
business leaders and business schools. What
emerges in the findings is closer to a stewardship model characterized by high standards and
expectations, role modelled throughout the
organization.
The following is a description of a low performing firm, does it remind you of anyone you
know or an organization you work with?
Low performing firms have a focus on a narrower
range
of
financially
driven
metrics.
Discussions about culture and performance
were dominated by bureaucratic process and
internal structure rather than customer satisfaction or end product. These companies did not
have energy or real passion about the business
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Editorial & Comment
or any restlessness with the status quo.
Leadership in the lower ranking organisations
focused more on ‘what the numbers say’ rather
than how top managers behave and interact
with others. Interactions were more formal,
structured and set piece in format. (Work
Foundation 2005: 7)
Excitingly, now we have the beginning of
the answer to my earlier question as to why
some organizations get it so wrong. Perhaps
knowing this, we, as critical friends, could ring
the alarm bells earlier and have a framework to
articulate our concerns. Too often we ignore
research from other fields as unhelpful or irrelevant. This report definitely is helpful and
could realistically help us crack our own codes
to improved performance.
Reference
Work Foundation (2005). Cracking the Performance
Code: How Firms Succeed. London: The Work
Foundation.
SUSAN HAMER
Editor
Comment
Out of the ashes: Learning
from the England cricket
team
Practice development knowledge can come from
small, unlikely sources. Six years ago, in August
1999, the England cricket team lost a test series
against New Zealand, two matches to one, and
captain Nasser Hussain was booed by the crowd
when he appeared after the match. In September
2005, with satisfying symmetry, the current team
drew the final match, won the ‘Ashes’ series
against Australia, again by two matches to one,
and captain Michael Vaughan was cheered
enthusiastically by the crowd.
In the years between the first event and
the second, several factors have led to this
change in sporting fortunes, in particular,
changes to team and individual approaches,
led by the England and Wales Cricket Board
(ECB). Firstly, more care has been taken of
health and fitness programmes for individual
players, with observably improved team and
individual performances. Secondly, a central
contract system was introduced, which ensures
England players can perform at peak levels
internationally. Thirdly, continuity of selection has raised the self-esteem of players,
which undoubtedly has contributed to the
Copyright © 2005 John Wiley & Sons, Ltd.
change in team fortunes, too. Fourthly, players
have been encouraged to celebrate each others’
successes, adding to the strengthened team
ethos and better morale.
Many other factors have been noticed, but
these examples are illustrative of the potential
benefits to be gained from prolonged and systematic focus on individuals and teams in practice development. When I discussed possible
themes for this issue with Susan Hamer, she
mentioned the growth of great things from
small beginnings. I doubt she was thinking of
reflections on the improved state of English
cricket during the last five years, but why not?
It provides an appropriate commentary to this
issue’s Learning Links pages.
ROGER COWELL
Associate Editor
Learning Links
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