03 April 2008

Car parks & other weak links

Good organisation means paying attention to detail, and aiming for the highest standards, even if you don't always reach them. But what if you have a culture in which it is regarded as correct to have a relaxed attitude to detail, and in which high standards are seen as conflicting with an egalitarian ethos? (Aiming for high standards may go with trying to be better than others, or even — heavens forfend — feeling superior.)

From the discussion forum Grumpier Old Men here are two stories, from different individuals, about the British state medical service — the one which Michael Moore would like America to emulate. Via GP Dr Crippen, who says "It is not exaggerated. I see it every day, day in, day out."

Have a heart attack, I did on Thursday night ... I needed an Angioplasty, and a stent. Because Milton Keynes Hospital did not have an on call surgeon to perform the op, I needed to be moved to the JR hospital in Oxford, about 40 miles away ... Some bright spark decided that time was crucial, and asked my wife if she would help save time at the other end by shaving my groin in preparation for the angioplasty ...

Then the hospital needed to provide an ambulance with a member of staff trained on the defib machine to take me to Oxford ... after 45 minutes of listening to a matron drone on about needing to check protocols and ensuring that all risk assessments were complete, they drove me to Oxford. For 45 minutes my heart was being damaged but nobody moved because of the [health & safety] mafia ... Finally got to Oxford, and the 40 minute operation took two and a half hours, but I came out ok.

At 7 am, after a stressful night, my wife went back to the car in the car park in the JR hospital. When she [had] arrived at 3 am, all the barriers were up and no ticket was issued. After 6 am, you need to pay with a ticket to get out. Because she had no ticket, she could not pay. Because she could not enter the car park, she could not get a ticket. No parking staff were available until 9 am. For an hour she was trapped in the car park, until someone else who was trapped measured the gap and found she could just fit along the pedestrian pathway and leave illegally ...

Then Milton Keynes hospital said they did not want me - sorry, no bed available. I was kicked onto another ward, and kicked out after two days. Never did get back to MK, never did get the proper cardiac debrief session from a doctor. They needed me out of the bed, so I went to the transfer lounge, and waited for my five packs of pills. Four hours later, I finally got my pills.
and
[Friend with broken ankle] arrived in an ambulance, no wheelchairs availaible on arrival to casualty. Eventually they found a swivel office chair on wheels. They wheeled her in. She waited 4 hours to be seen, after having spent 2 of them desperate for a wee! Yep think its broken you need to go to xray!! No porters availaible. She phoned a friend, friend arrived to push her on office chair to xray! Yep its broken you need to go back to casualty. Friend wheeled her back ...

Back in casualty waited another hour to be told she had to go to fracture clinic. Friend had to leave to pick up children from school. Still no porters, arrival of a neighbour who took over portering duties and wheeled her to fracture clinic. She was impressed as to the choices of colour of cast she was given!

Back to casualty (again!). OK you now need crutches so you have to go to physio dept. Neighbour had to leave to see to her and friend's children! Still no porters, by this time she had seriously lost the plot!! She had arrived at 9.45 and it was now 5.30, nothing to eat or drink, no feedback as to after care. Eventually a porter was found, crutches distributed, pushed back to casualty, had to contact a taxi to take her home. Time now 7 pm. She arrived home and pulled herself through the front door depressed at the thought she had to return the next day to have cast replaced!!!!!
I wonder whether there are any illuminating parallels with the Terminal 5 fiasco, where small mundane things such as car parks again turned out to be important in the scheme of things.
Almost 300 flights in and out of Heathrow Airport were cancelled during the first five days as teething problems at the new Terminal 5 caused chaos ... The problems appear to be due to a combination of factors. Some were technical, involving glitches with the sophisticated new baggage set-up, which is designed to handle 12,000 bags an hour.

But other issues were more mundane. Employees arriving for work, for example, could not find their way to the staff car park ... The first warning signs came as early as 0400 GMT on Thursday when passengers began to arrive, only to be confronted with the same problems as the staff in trying to find somewhere to park. The road signs were apparently not clear outside the terminal, and people said they were given wrong directions once inside.

But that was only the start of their problems. All the check-in desks were apparently closed at 0400 GMT, leaving passengers no option other than to form a queue. (BBC News)
No matter how many training courses, checklists and other safeguards you institute, the underlying ethos and motivation will show through. Lower people's interest in standards and, sooner or later, you are likely to get lower standards. And attitude to standards is probably not unconnected to how one feels about doing things for other people.

* * * * *

Consider the post office closures. I realise there are all sorts of arguments about market forces, whether you should have subsidies, whether there are bureaucratic obstacles, and so forth. But look at the ultimate outcome. We have a government that seems willing to spend freely on schemes which are supposedly in various people's best interests, but which as far as I'm aware have not resulted from the electorate's urgent demand for them — e.g. food education programmes, citizenship classes, "ethnically diverse police mascots". Yet this same government appears to have little interest in maintaining a service which a large number of people clearly find highly desirable. As usual, market arguments are applied selectively. *

In a mediocracy, the concept of service has been redefined. This is because the idea of one individual doing useful things in accordance with the wishes of another is considered too threatening. People are taught to find it demeaning to be useful. They are encouraged to believe that they should not have to do simply what other people want, and to feel instead that they have a right to exercise their judgement and creativity. Ironically, this ethos is described as 'individualism'.



* Interesting, incidentally, that Simon Jenkins ("stop wailing") seems to have changed his mind: he now appears to be in favour of retaining village post offices. Also, he uses the word "Orwellian". Flattery indeed.