My father used to delight in telling me the old army saying: “If it moves, salute it; if it doesn’t move, pick it up; and if you can’t pick it up, paint it.” To him it summed up all that was wrong with hierarchical bureaucracy. Unfortunately, this mentality wasn’t left behind in the army of the 1940s; it’s alive and well in health and social care more than 60 years later.
While the new “command and control” management clothes itself in the fashionable garb of performance management and target-setting, of quality assurance and “excellence”, it’s still the same old story. Management tools or techniques such as these have limited uses in specific circumstances. They are not in themselves a coherent or viable management philosophy.
Many organisations and their managers are prone to self-importance and vanity. Some don’t realise that the bigger they puff themselves up, and the higher they climb, the more we can see their nether regions. A little modest realism wouldn’t come amiss.
A medium-sized charity has recently set about “modernising” its residential care business. This amounts to glossy brochures, a three-year plan and lots of target setting. They are just following the fashion, but the tragedy is that the fashion they are following went out of vogue years ago in progressive commercial, industrial and social enterprises.
It doesn’t work because it’s wasteful, top-down, centralised and bureaucratic, and it diverts effort and energy from the job in hand.
One of the objectives of this organisation is to “achieve excellent inspection results from the Commission for Social Care Inspection”, moving from 68 per cent of standards met to 99 per cent. Another is to “increase care homes’ customer satisfaction” from 70 per cent to 90 per cent. Why choose those particular figures? What about the 10 per cent of customers who are still not satisfied by the time the target has been hit and there are congratulations, champagne and pay rises all round?
These are centrally set targets, each allocated to a director to “drive through”. Nowhere does the grand plan say “provide the best possible care and accommodation” which, presumably, is the core objective of the organisation.
In answer to their own question “Why do we exist?” the plan’s authors come up with: “We provide excellent homes and innovative services to help people seize opportunities”.
This is management waffle intended to obscure the fact that they do not know the answer to their important question. If the homes are excellent now, is it possible to get more excellent? Is meeting 68 per cent of the standards excellent?
Innovation doesn’t come from central management; it comes from developing ideas and practice in the homes, where the real work gets done.
The top and middle ranks of the social care establishment are riddled with this self-serving nonsense. Because of it there is simply less service. The people who are meant to get a service and those who give it are worse off. They not only have to struggle with the circumstances the service was set up to improve, they have to bear the burden of a management fashion that has never worked for anyone but those who perpetuate it.
Management is about getting things done – the right things in the right ways. Yes, it’s essential to ask why we exist because to succeed you must pursue the core task and cut out all the extraneous activity. It’s simple but far from easy.
And it’s rare in our current management culture. For example, despite all the rhetoric to the contrary, care home managers find themselves preoccupied with meeting the demands of their central offices, the requirements of CSCI, training targets and other people’s budgets, rather than meeting the needs of the residents. They are diverted from their core task by their efforts to comply with the insatiable demands of everyone except their residents. And our system is so distorted that compliance with such demands is valued more highly than getting on with the real job.
- Ask the question “what is our task (without which we have no reason to exist)?” and then concentrate all your resources on doing just that.
- Set your own standards, focused only on the needs of the people who use your service.
- Make sure that everyone signs up to and believes in both the task (what you do) and the standards (how you do it).
- Use management tools and techniques (including performance targets, quality assurance) as core objectives.
- Work to other people’s standards and measure your success by how “compliant” you are.
Name: John Burton.
Job: Independent social care consultant and writer. He is author of Managing Residential Care,
Qualifications: Certificate in the Residential Care of Children and Young People; the Bristol University Advanced Course; the advanced consultancy course at the Tavistock Clinic; MA Public Policy; and a diploma in counselling.
Last job: Regional manager, English Community Care Association.
First job: Community service volunteer.