REVIEW: FREEDOM FROM COMMAND AND CONTROL - A BETTER WAY TO MAKE THE WORK WORK

Put the the customer's needs over those of the target, reads Neil Goodwin

In the world of top-down, command and control management, this book is seductive because it argues there is a better way to design and manage work.

Seddon believes managers should think of organisations as systems rather than hierarchies - he invokes contrasting US and Japanese approaches to car production to underscore his argument.The Japanese believed the product was 'pulled' through the system by the customer with an emphasis on low cost and high quality while the Americans saw work in progress as being 'pushed'by management schedules leading to an increase in volume and decrease in costs.Seddon argues that history has shown which approach has been more sustainable.

He says the moral of this story for service organisations is that failure to meet consumer demand is caused - not surprisingly - by organisations that do not work properly.Seddon says the NHS is too preoccupied with targets, resulting in managers focusing primarily on personal survival by delivering the plan - which is often achieved at the expense of consumer satisfaction.The problem is simple: the use of targets in a hierarchical system engages people's ingenuity in managing the numbers instead of improving performance.

This sees increases in performance variability, waste and costs, a demoralised workforce, and disrespect for management.

Seddon's answer is that organisations should consider their purpose to be serving consumers, rather than solely delivering a plan.

Instead of managers pressurising their staff to work harder and faster, both should work together to respond to consumer needs.

He argues that all targets for public services should be removed and public sector organisations should establish measures to help them understand and improve performance instead.This philosophy lends itself to the abolition of the specifications and inspection industry because managers and professional staff rarely respond to change prompted by visits from third-party regulatory bodies.

Seddon's arguments are very compelling.They support the government's policy direction in which the patient coming first in everything the NHS does, although it is questionable if we will see the removal of targets and national regulators.

However, this should not stop managers reading this book and thinking through how their organisation should be run in a not-too-distant NHS, where we are more comfortable with target achievement and personal survival.

Freedom from Command and Control - a better way to make the work work By John Seddon Publisher: Vanguard Education. ISBN 0 9546183 0 0.£20 Neil Goodwin is chief executive of Greater Manchester strategic health authority