Errors…

Errors... NHS_Training_in_Primary_Care_General_Practice

They’ll deny it, supporters will poh-poh it but government has made some horrible decisions, screwed up and got a lot of things wrong.

That is story of all governments, over all of time.

Don’t agree?  Well, how about… the poll tax, personal pensions mis-selling, Child Support Agency, UK’s exit from the ERM, The Millennium Dome, Individual Learning Accounts, Tax Credits, the Assets Recovery Agency, farmers’ Single Payment Scheme, various IT projects, the London Underground public-private partnership, and identity cards.   

System failure, individual misjudgements and the refusal to learn from previous flops.  Or, even admit things are going wrong and fixing them.  

To do so means, to be associated, for ever, with a foul-up or failure.  The pressures of damaging a political party’s electoral prospects or an individual manager’s career, stops any admission of failure, in its tracks.

Now, we are focussing on unlocking Britain.  The road to somewhere is paved with good intentions.  The road from lockdown seems to be crazy paving.

Confusion and cart-before-the-horse announcements, it’s a muddle and causing a distraction from the real task of getting out.  

1.  Make a note; if you have to keep explaining it, you shouldn’t be asking people to do it. 

2.  Make another note; telling people to lock down is instant and easy, showing them how to unlock is highly complicated.

3.  Reread note 1.

Many of the key CV-19 decisions have been wrong, or too late.  Why?  

Because the people making the decisions are no better at it, than you and I and because they are like you and I, their decisions are based on cognitive bias… the mental shortcuts we all make, to make sense of the world.

There are a lot of them…

Cognative bias; we believe what we want to believe.  The NHS is the best in the world and well prepared for a pandemic.  It wasn’t.  

We wanted to believe the NHS would see us through.  Following a gargantuan effort, it has.  However, because we think the NHS can do its stuff, everything else will fall into place.  Actually, much of the non-NHS activity has been little short of a disaster.

Conformity bias;  when decisions are made the tendency is to fall in behind.  Ever more in the world of politics.  First PPE, later care homes each brought their own problems, which government denied.   

Politicians, like us, take their behavioural clues from the actions of their leaders rather than exercise their own judgements.  It was weeks before the government was forced to react.

Authority bias; favouring the decisions of authoritative people.  ‘We are following the science…’ 

Loss aversion-bias; once a decision has been made, once we have an emotional attachment to it, we stick with it… testing in wind-swept car parks, miles from anywhere, expecting symptomatic people to find their way, without a car. 

Optimism bias; hoping tracking and tracing with 18,000 new, untrained people will work and a brand new App will work from Version 1.

How to avoid bias?  There are two ways.

The first; start with the person and work backwards.  

Feeling rough, at the end of a 12hour shift, faced with the prospect of a 30 mile round trip for a test?  

Try and get an appointment on line… no thanks I’ll give it a miss and take some paracetamol.  

Send for one in the snail-mail?  Yeah, right.

Start with the person and you make it easy for the person.  Start again, put the testing centre as near as possible to where they work or live; gas-station, school, police station, high street, hospital car park.

If you start with the system, you make it easy for the system and no one comes.

At the best of times, decision making is a tricky business.  The men and women who are making the decisions have skin in the game.  The more decisions they make, the more they have at stake.  The more they have to protect and that leads to…

...the second way to avoid bias…

… involve more people in the decisions.  Consult widely, be transparent in the process and ask for opinions.  

Seek out the contraryists and be open to errors.

News and Comment from Roy Lilley

Contact Roy – please use this e-address roy.lilley@nhsmanagers.net

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.