More ducker than Drucker…

rimary care training_NHS_More ducker than Drucker...

Got any problems?  Money, relationships, work, the neighbours, the kids.  

Problems… who hasn’t!

In the world of management there are four types of problems.

1.  Truly generic.  

Peter Drucker wrote;

“… truly generic, of which the individual occurrence is only a symptom.   Most of the problems that come up in the course of the executive’s work are of this nature.”

2.  Generic and unique.  

Like a merger or a take-over; non-recurrent but something that happens all the time.

3.  Truly exceptional and truly unique

The unique circumstances that caused the recent power outages that brought the railways to a standstill.

4.  Early manifestation of a new generic problem.

Is a unique event likely to happen again… more power outages, for example because of system fragility.

Solutions finding is easier when you know what type of problem you have. Treat the root-cause, not the symptom.  

How do you do that?  Keep asking why and also, ask if anyone else has had the same problems… how did they handle it?

And, the king of problems; Wicked Problems.  

First described by C.West Churchman.  Wicked problems are not true or false, essentially unique and cannot be solved by trial and error.  

For example, the environment or economics where stakeholders have radically different world views and frame the problem differently.

If what I’m hearing is right, today the election Parties will tell us about their plans to solve the problem of adult social care.

What kind of a problem is it?

I think it’s straightforwardly generic and the root cause simple to define.

The problem is not that there are too many older people.  We’ve seen that coming.  The problem is; there’s not enough money to pay for their needs.

Here we go… keep asking why!

… because we haven’t raised enough in taxes…

Why?

A sustained period of austerity obscured the issues and the longer it has gone on, acted as a disincentive for government to deal with the issue.

Why?

Raising taxes is thought to be a disincentive for voters.

Why?

Actually, we don’t know, we haven’t tested the idea at the polls.  It is an assumption.  It could be voters would be receptive to a tax-based solution to this problem.

As a result, we are now in the territory of the manifestation of a new generic problem.  

Local government cannot cope, the knock-on effect is creating healthcare demand, pressures on the workforce and distress for families and individuals.

Solutions?

Taking the NHS as an example; we all run the risk of accident, illness, childbirth and disease.  To meet the costs as individuals makes no sense, to insure adds costs, so we agree to subscribe to a mutual, social system.  If we need help, the money’s there, if we don’t, we thank our lucky stars. 

Old age?  We all face it.  Some of us will be fit and healthy and die on the golf course… others will have a miserable old age coping with diseases for which there are no cures.

It makes sense for us all to pay.  They do in The Netherlands, Sweden, Germany, Japan, France and Korea.  

In addition, it makes sense for government to recognise a protracted, assisted old age is going to need health-care, nursing-care as well as personal care.  

There’s no point in making an artificial demarkation between nursing and personal care, it just makes some of the care dangerously under skilled, creating system failures and costs, like hospital admissions.  

Contribution of personal assets towards care-home costs?  

If we want to, the answer is simple.  Create a ceiling for contributions.  That way insurance companies can make actuarial calculations and create products… because they can calculate the risks.  

Citizens can make provision, if they want to and are able.  Give tax relief on premiums.

Domiciliary care?   Learn from other countries; the German system can pay relatives up to £1,784 pcm and training, to become full-time carers.

Adult social care is not a wicked problem, it is not an exceptional problem, nor a unique problem.

This is a generic problem, with bog-standard generic solutions.  

The art of management and for that matter, politics, is to make problems so interesting and the approach to solutions so doable that everyone wants to stop ducking them and roll up their sleeves and fix them.

Are politicians more ducker than Drucker?

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.