Despite having been in the service improvement business for years, I choose now to finally really get my head around “lean thinking” as inspired by Taiichi Ohno’s work on the Toyota production system.

Apparently Toyota have a sign saying “problems are good” on the factory floor. In light of their mass recalls, I guess this gives them an opportunity to really practice being a learning organisation.

My late enlightenment stems from reading John Seddon’s, increasingly influential Systems Thinking in the Public Sector, which draws on lean thinking to inform a radically different approach to the command and control top-down target culture that he so ruthlessly excoriates.

In essence the argument runs like this. In a top-down target driven culture, the targets generate measures, and feeding those measures becomes the de facto purpose of the organisation. Practice in the organisation is therefore constrained by the overriding imperative to achieve those measures.

In a systems-thinking approach, design is determined by purpose as seen from the patient’s perspective. Measures are derived that inform how the organisation is meeting that purpose and this liberates method – aka “innovation”.

Not all targets and measures are bad, only those that are imposed from above without being informed by data on how the system would perform without them. It is senseless to impose an arbitrary target without understanding how the current system works in terms of demand, capacity and flow.

Bizarre consequences

If capacity is below the target, the system has to distort itself to meet it or people have to cheat. If it is above the target the system will work to the target and not its true capacity. If the target sits within the natural variation of performance within the system, sometimes the organisation will win and sometimes it will lose. Seddon provides a host of horror stories of how imposed targets create bizarre unintended consequences with dire consequences for the patient.

The real danger in all this is that in straightened times leaders and the centre may resort to more command and control – the exact opposite of what the King’s Fund advocated in their Windmill 2009 simulation. Taking a systems-thinking approach means moving away from an attitude that sees staff as essentially unable to perform unless motivated by carrots and sticks. The research evidence instead suggests that staff will be more likely to innovate when their intrinsic desire to do the right thing is liberated.

As Seddon states: “The reform regime is based on negative assumptions about people in general and public servants in particular. Decreeing specifications assume they don’t know what to do, don’t want to change and need to be coerced or incentivised to act.”

He is highly critical of the “managers as brains; workers as bodies” assumption that if the right information flows upwards, and the right decisions are made on the basis of this information, the right instructions will flow neatly downwards to be converted into actions by staff. This merely leads to managers who are disconnected from reality, demoralised, unthinking staff, because they have been told to be unthinking, and fragmented processes where managers are the only ones who can make decisions, so people have to keep referring things on.

Seddon argues that the manager should be an explorer from the outside of the system in, always investigating what adds value to patients. He reckons only about 5 per cent of management time should be concerned with people management and the rest to making the system work. 

The impression I am getting from people experiencing this approach is that this may not be quite right. For systems thinking to fully embed it needs both proper job design to meet purpose and affirming and engaging leadership practices that recognises that staff have brains, bodies and attitude.  

For more on John Seddon’s approach to systems thinking visit www.systemsthinking.co.uk