How do you determine who the bad performers are without putting everyone on edge. Demmings line was that if you wanted to improve system performance, first drive out fear?
Ken
Sent from my Verizon Wireless BlackBerry
-----Original Message-----
From: Adam Oliver <[log in to unmask]>
Sender: Anglo-American Health Policy Network <[log in to unmask]>
Date: Thu, 15 Dec 2011 12:33:46
To: <[log in to unmask]>
Reply-to: [log in to unmask]
Subject: Re: Performance management
I actually think it's the other way around. For persistent bad
performers, you might usefully employ naming and shaming (or at least
some kind of close scrutiny). For one-off bad performers, the poor event
may be just be down to bad luck, or a temporary slip, so you don't need
to worry about it so much.
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: 15 December 2011 12:31
To: Oliver,AJ; [log in to unmask]
Subject: Re: Performance management
Presumably the question relates to whether you are talking about one-off
poor performance events, where 'blaming' would probably work, as it may
help get the person back on track, and persistent poor performance,
where there is a deeper underlying issue which blaming isn't likley to
do much for?
-----Original Message-----
From: Adam Oliver <[log in to unmask]>
Sender: Anglo-American Health Policy Network
<[log in to unmask]>
Date: Thu, 15 Dec 2011 12:24:50
To: <[log in to unmask]>
Reply-To: [log in to unmask]
Subject: Re: Performance management
I do think there is something in naming and shaming against persistence
'offenders', providing that it is done carefully.
However, my question arose really because, Kahneman points out that a
lot of the time, people think that blaming works, when it's really
mainly regression to the mean. For example, in one of his examples,
Israeli pilots who flew badly got severely scolded by their flight
instructors, and the next time they flew, they improved. But this was
because there is very little chance that a pilot will fly badly
consecutively twice - if you say nothing to them, or praise them, they
are also likely to improve after a bad flight. So I was speculating
whether something similar happens in health care.
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Calum Paton
Sent: 15 December 2011 12:12
To: [log in to unmask]
Subject: Re: Performance management
Ken, interesting, thinking of your observation.....
Is there a difference between 'naming and shaming' the 'poor bloody
infantry' (eg on production lines) and naming and shaming 'bosses' eg
Chief
Executives of NHS hospitals....the latter receiving a lot of prominence
in
the English NHS (more than the rest of the UK) a few years ago - and,
now,
in the academic literature - as to whether 'targets' (and 'terror')
worked
(eg work by Bevan; Propper...)
The boss (or Board) may after all be responsible for the 'whole
process'....at least on paper.....but a hospital is of course at the
mercy
of the wider health polity (eg central control in the English NHS,
whatever
the prevailing rhetoric) and also of the more local 'health economy'
(ie
its local commissioners and meso-level regulators at area or regional
level)...
A few CEOs/ Executives sought to 'hide defects' (ie fiddle waiting
lists/times) but that was a dangerous game....
As to whether 'profit' (market) means faster corrective action than
targets
(state), Max, the jury is so far out, so far, that we don't know, to be
fair...although the (limited) English NHS-specific evidence from the
2000s
suggests the latter, state action......and all sorts of questions arise
as
to - eg- whtehr nursing homes are or are not similar to hospitals, let
alone
the rest of the economy...
This one will run and run....
Happy Christmas everybody,
Calum
Calum Paton
Professor of Public Policy
School of Public Policy and Professional Practice
Keele University
Editor-in-Chief, International Journal of Health Planning and Management
(Wiley Blackwell)
[log in to unmask]
See Calum Paton, 'NHS Confidential: Implementation, or...how great
expectations in Whitehall are dashed in Stoke-on-Trent', in M. Exworthy
et
al., Shaping Health Policy: Case Study Methods and Analysis, Policy
Press,
2011
See special issue of International Journal of Health Planning and
Management, 26.4, 2011
See Calum Paton, New Labour's State of Health: Political Economy, Public
Policy and the NHS, Ashgate, 2006
-----Original Message-----
From: Kenneth Thompson
Sent: 15 December 2011 11:36
To: [log in to unmask]
Subject: Re: Performance management
Hi Adam
My understanding is that Demming had long ago discovered that shaming
actually impeded any efforts at quality improvement for two reasons
1) most problems in quality were in fact related to systematic problems
in
process
2) the introduction of shame/fear actually encouraged people to hide
defects
or created conflict as blame was assigned.
Have these ideas been stood on their head?
Ken
Sent from my iPad
On Dec 15, 2011, at 6:07 AM, Adam Oliver <[log in to unmask]> wrote:
> There is a lot of talk/analysis etc at the moment on whether shaming
> people for bad performance can improve performance. It seems to, but
> could the improved performance of poor performers be at least in part
> explained by regression to the mean? We probably need to have some
kind
> of controlled experiment, one arm that uses encouragement of bad
> performers, and another arm that uses shaming. We could then see which
> (if any) has differential effect. It would be an important thing to
do,
> across all kinds of sectors and scenarios, I think.
>
> Please access the attached hyperlink for an important electronic
> communications disclaimer: http://lse.ac.uk/emailDisclaimer
Please access the attached hyperlink for an important electronic
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