This 
morning, I listened with increasing dismay to various politicians, officials and apparatchiks talking about unusually high numbers of deaths in some NHS trusts. This comes on the back of yesterday’s disclosure about the demise of the Liverpool Pathway and reminded me of all the troubles laid at the hands of bankers in recent years.
It seems to me that what we have here are a series of systemic failures each of which leads to discussions first of all about who to blame and secondly about which processes and procedures needs to be written, rewritten or improved. But to me all of these discussions miss the core point – that the failures are not of systems, processes, procedures, policies or off whatever artefact you want might want to name, but of people. It is about NHS managers who decided that meeting financial and operational targets was more important than caring for patients; it is about bankers who decided that personal and corporate profit was more important than the health of the global economy. These are ethical issues, not process or policy or regulatory ones.
And that is where thinking starts to fall apart. We are going to have a new banking code, the Liverpool Pathway is to be abandoned and the new one written, there is to be an enquiry into the failures of the NHS trusts with excess deaths. But all we will end up with is another set of regulations, policies, procedures etc designed to constrain future behaviour on the evidence of past events. Regulation, for what it is worth, is always behind the event. What none of this does is address the core ethical issue. I have worked in regulated industries and also do some work in the NHS and I am pretty certain that most of the employees I have come across want to do the best they can for their customers or patients. The woman who comes out to mend a burst in the water main outside in the road, or the man who massages a patient’s legs to prevent bedsores, has probably never read the reams of regulatory and policy guidance and nor should we expect them to. Surely what we expect of them is that they have the customer or patient at heart and I know that what most of them want to do is what is best.
Let me tell you a story. Throughout the autumn of 1995 and the early spring of 1996 I was part of a team that was leading a response to one of the most extreme droughts the country has ever seen. So severe was this drought that there was a very real possibility that customers would first of all have their water usage massively restricted and then even run out. At one early point in the proceedings, a view was expressed that this was “OK because our regulatory deal allows us to cut water off every 125 years”. The realisation that this was OK in principle, but far from acceptable in practice, occurred quite quickly. Once every 1 25 years sounds okay until those odds mature during my lifetime when I certainly do not expect to pay full price for a non-existent service. This recognition, and it was very clearly expressed by the CEO when he said “We will not run out of water whatever it costs”, galvanised employees in a way that was a delight to be part of. We maintained supplies at all times.
How many other managers and leaders in the banking and NHS continue to drive regulatory targets even when they contradict the principles of good patient care? It is too easy to get captured by regulation and to start to think that meeting regulatory requirement is the be all and end all of managerial leadership. I would suggest that true leadership is about making the regulators redundant by consistently delivering what the customer needs. After all regulators have often been described as pseudo-customers, put in place because the individual customer has too weak a voice. Well, let me suggest that success is about dealing with individual customers, each with their individual needs, rather than a surrogate represented by a regulator.
Success is about doing what is right, not what is allowed for in, or at the very edges of, regulation. We do not need more rules, we need states of mind that put the customer first whilst recognising the (often financial) constraints of the system. Isn’t it strange that so many people seem to think that the way to fix a systemic failure is to tinker with the very causes of that systemic failure. As someone[i] once said, “If you always do what you always did, you always get what you always got”.
It is time to do something different, not more of the same.
[i] In the modern world, many people attribute this quote to Anthony Robbins, renowned motivational speaker and self-improvement guru. Go back a few years, and people will tell you that Albert Einstein said it. Go back another generation or two, and Henry Ford gets the credit; before him it was Mark Twain. It doesn’t really matter which of these thought leaders said it. What matters is the truth of it…and the point of it.
