Why an Authentic Customer Orientation Requires a Transformation (Part I)

Are we living in an age of inhumanity, hypocrisy, and moral bankruptcy?

It occurs to me that we live in an age of greed, inhumanity, hypocrisy, and moral bankruptcy. I say that this inhumanity and moral bankruptcy both enables and is enabled by the doctrine of management. I say it is folly of the highest degree to be applying the practices of scientific management in the 21st century. I say it is folly to expect an authentic customer-orientation when the name of the game is greed: making as much money as possible, today, irrespective of the cost as long as the cost is paid by someone else – today or tomorrow.

I am clear that the cancer of greed, inhumanity, hypocrisy, and moral bankruptcy has spread from the world of big business into just about every institution – the government, the civil service, the police, the NHS – in the UK. And into society itself. Today we got a wake-up call, will we listen?

The NHS Mid Staff scandal: 400 – 1,200 human beings died as a result of poor care over 50 months

Let’s first get present to what has occurred. According to the Guardian:

“An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire. The report being published on 6 February 2013 of the public inquiry chaired by Robert Francis QC will be the fifth official report into the scandal since 2009, and Francis’s second into the hospital’s failings.

The often horrifying evidence that has emerged means “Mid Staffs” has become a byword for NHS care at its most negligent. It is often described as the worst hospital care scandal of recent times. In 2009 Sir Ian Kennedy, the chairman of the Healthcare Commission, the regulator of NHS care standards at the time, said it was the most shocking scandal he had investigated.”

What was the customer experience like?

Julie Bailey says head must roll. Why? Let’s listen to her describe the customer experience:

“You only had to open a ward door at the hospital to smell the stench of urine, hear patients screaming in pain and see staff being bullied, and know that the care was appalling.

My mum died in that hospital terrified of the people that should have cared for her. She was recovering from an operation when nurses dropped her and hurt her. After four days in the hospital I could see that unless I was there to feed and wash her she would have just been left without care. Even with me at her side, a nurse refused to administer a life-saving drug. My mother died a few hours later, eight weeks after going into hospital. She was a strong woman. She should never have died in there. In 2002, Dr Peter Daggett, a former senior doctor at the hospital, had already raised concerns that the hospital was out of control…”

Does this sound dramatic to you? Not to me. My father went to hospital with a stroke. Like Julie, I found myself at the hospital feeding and taking care of my father. I had to threaten to go to the media to get the care that my father needed.

What led to such shocking disregard for patients – their humanity, their wellbeing?

As one trained in systems thinking and modeling it is rather easy to figure out the what kind of system structure would cause that which occurred:

- start with an inefficient system that is just about coping with existing demand;

- inject increasing unrelenting demand including an ageing population;

- cut budgets significantly whilst insisting on higher levels of service;

- demand instant improvements which are most likely to be made through headcount reductions and other simplistic cost reduction measures;

- apply pressure through targets and leave targets open to being gamed;

- introduce a management philosophy and practices that are detrimental to an ethos of care, of public service;

- ensure that there is political pressure to provide a misleading/flattering image of the beneficial effects (better patient care, more efficient NHS) of the cuts and changes to the NHS.

Viola, you have a system that will look healthily on the surface, whilst killing customers – the patients in this case.

What does Julie Bailey say?

“This shift away from patient care started to happened under the Labour government. It destroyed the culture of care in the NHS by replacing it with a top-down, target-driven culture. Former health secretary Andy Burnham contributed to this. He wouldn’t even meet the grieving relatives at Stafford hospital and he only gave us a secret inquiry so that the NHS’s dirty linen wouldn’t be aired in public.

In 2007, I set up Cure the NHS, a patient campaign group formed to highlight the poor care at Stafford Hospital, following the death of my 86-year-old mother, Bella, after she went in for a routine hernia operation. While we were campaigning outside, Peter Carter, head of the Royal College of Nursing, visited Stafford hospital. He wrote to our local newspapers saying what a good hospital it was, with good management and good staff...”

To be continued in Part II – coming soon.

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