Kill Bill Vol III

Its been quite a year since the Bill was first published.  With calls to "kill the bill" it has at times been more like a real life version of a Quentin Tarantino movie.  At first what was general discontent grew into more serious opposition requiring the Government to put their plans on hold while they paused to listen to the concerns in more detail.   Then there was the letter from over 400 public health consultants to the House of Lords that they reject the passage of the Bill (see my blog here).

Commentators from Roy Lilley to the Kings Fund and many more in between have continued to highlight problems with the Bill.  Surveys have shown large numbers within professions are opposed to it.  Marathon debates in the House of Lords led to further amendments followed by actual marathons run by a doctor - he ran 6 in 6 days to highlight concerns about the Bill.  Incredible.  Others have said they simply don't understand it, most notably the Chair of the NHS Commissioning Board, Professor Malcolm Grant.

Yesterday the Royal College of Nursing, The Royal College of Midwives and the British Medical Association declared outright opposition to the Bill.  Lansleys response to the opposition was more "Kick Ass" than "Kill Bill".

But if there is one thing that everyone can agree on it is the lack of understanding and knowledge that exists.  The problem is that this is an accusation that is levelled by supporters and detractors of the Bill at each other.

Watching the debates unfold, in the light of my experiments with wellbeing systems, understanding and knowledge is indeed missing.  But it is an understanding of the system, outside in from a users perspective that is missing as is empirical knowledge about what works, not the nuances of the substance of the Bill.

For me, Lansley is right to make those who do the work responsible for making the work work.  He is right to move away from delivering targets as the de facto purpose of the system.  But I have yet to hear him speak about the purpose of the proposed changes in a way that makes any sense about what we are moving from, what we are moving to and why.  Maybe I am just not clever enough...

What the Vanguard Method does is to put people who do the work in control of the work.  Because they see that the results of their efforts to improve the work are making a profound impact on the experience of the people they care for, morale improves.  Relationships become more productive both within and across teams.  The relationship with managers moves from one of control from a hierarchy to a more collaborative one where the manager acts on the system and removes obstacles that are beyond the immediate control of those doing the work.  They can then carry on creating value for users in the pursuit of perfection.

Costs come down, staff do good work, outcomes improve and patients and their carers love it.  All because the starting point is to understand purpose from a users perspective and people are given a method to get knowledge.  Its that which needs to be done at scale, not more debates about structures and organisational forms.  No targets, no incentives, no "lean" tools, not even a plan.  Imagine that.

The challenge for policy makers is to move from opinion to knowledge based on a profound understanding of what works, gained from experimenting.  What is needed is a pathological focus on purpose from a users perspective, not competition.  What we design should, therefore, be a consequence of knowledge, not an inevitability of policy.  Without a method for putting those closest to the work in control the best we can expect is that leaders pay lip service to the idea whilst concentrating on delivering what the centre wants from them.

In the end I don't understand the purpose of the Bill either.  And even those who know the detail of the Bill would probably struggle with purpose (from a users perspective) I imagine.

If it results in leaders that understand purpose from a users point of view, uses measures that relate to the delivery of that purpose and designs from studying and experimenting rather than "planning" or "specifying" then it has my support.  Because if you do that you will drive out costs by managing value far in excess of anything that could be conceived through conventional thinking.

The problem is that I don't think the Bill helps change thinking in that way at all and so another opportunity to change and do better things will be lost.

One final thought.  Wikipedia has this to say about Kill Bill:

"A. O. Scott of The New York Times said Tarantino's previous films Pulp Fiction and Jackie Brown were "an exploration of plausible characters and authentic emotions". He wrote of Kill Bill Volume 1, "Now, it seems, his interests have swung in the opposite direction, and he has immersed himself, his characters and his audience in a highly artificial world, a looking-glass universe that reflects nothing beyond his own cinematic obsessions." Scott (also commented on) "the hurtling incoherence of the story" "


I wondered if there were any parallels with what is currently happening