April 26, 2018 Nick Downham

Lacking purpose – do we really know what ‘it’ is?

Nick Downham – Oct 2018

© Cressbrook Ltd 2018 – All Rights Reserved

This is an additional post built on my observations of the Netflix film, War Machine, and the parallels to the NHS. See the original post here.

In addition to the parallels between the NHS and the US military in the approach of trying to do the wrong thing righter, another key issue was explored midway through the film. Brad Pitt’s General Stanley McCrystal is seen addressing young soldiers in a forward operating post in Afghanistan. He tells them that they have got to do ‘it’. If they do ‘it’ they can win this war. Of course the tired and exhausted soldiers are utterly confused. One asks what ‘it’ is. What are they trying to do? Who are they trying to fight? Everyone looks the same. Most people don’t want them to be here. There is no traditional enemy to fight.

They are unclear of their purpose. NHS organisations sometimes fall into the same trap. Of course the NHS is all about safe, quality care, free at the point of use and the efficient use of public money. But what does that actually mean? Does our version of that add up to what patients and public need? OR do we design our services around our version of what patients need? Around labelled needs**? Are we able to do what matters for patients? As a health service we are technically amazing but in many cases we don’t seek to understand what matters; we just assume we know. The net result is that many of our services are not as effective as they could be. They are great at treating the presentation, but in many cases not the underlying issues. And so many patients loop round and round.

This question is, of course, the reason why the first Lean principle is value. It challenges organisations to spend time to identify just exactly what their customers / patients value. John Bicheno, in his book Service Systems Toolkit, describes this first Lean principle in the context of service organisations as identify purpose.

So it comes round to not assuming we know what ‘it’, or ‘value‘ or ‘purpose‘ actually is. It takes great effort to figure it out, and, like Brad’s character, the answer may not suit our current ways of thinking and organising.

I hope you found this useful.

**A term I learnt from the work of Richard Davis in his book Responsibility in Public Services.

Contact Nick