Primary Care Training_NHS General Practice_Motoring...

Do you drive… 75% of us have a driver’s license.  That’s about 33.5 million people.

Last year Japan made 9.5 million cars.  Globally, about 100 million vehicles were manufactured.  Most of them in China, who export very few.  Curiously, the US, only made 13 million.

Germany made 6 million and the UK a worryingly, declining number, down to 1.7 million.

When they’re electric we are going to need a lot more power stations and a way of dodging the charging cables dangling from yer bedroom window, down to the kerb-side.

The history of auto-manufacturing… bone-shakers, to the exquisite quality we enjoy today, one built every 86 seconds, assembling 30,000 parts, is fascinating.

The car market in Japan was opened up by the Locomobile Company of American Agency in 1901, steam cars.

After two world wars, bureaucracy and limitations, the Japanese car industry really got going in the late 50’s, early 60’s.

There is a famous case-study;

… it tells of a worried US car industry who went to Japan, to see for themselves what sort of a threat Japanese exports might pose.

They returned and wrote; 

…Japanese taste and style is very different from the US, the cars are of poor quality.  There is no prospect of them exporting to the US, from that distance, supporting a dealership network, providing spares and make a profit.

Enter… Toyota!

Following the second world war US investment and one name, stands out in the history of Japanese manufacturing’s rise from the ashes.

Edwards Deming.

An engineer and statistician, he began work in July 1950, at the Hakone Centre and in particular with the Toyota company.  

Deming is credited with being the inspiration for the post-war, Japanese economic miracle, the ten years 1950-60.

His work was ground breaking and he’s regarded as a hero in Japan, and to anyone who understands the practice of management and the pursuit of excellence… iconic.

As a result of his work, we have Deming’s 14 Points of Management, as current today, as when he wrote them… the third points says;

‘Cease dependence on inspection to achieve quality…’

Toyota’s commitment to quality went on to give us Six Sigma, Lean and the 5 Whys.  

All based on Deming’s observations of human behaviour, relationships with staff, making work, work and how we should create relationships with suppliers.

If we are prepared to listen, there are lessons here, for the NHS.  If we will just stop for a moment and think, there are things to learn.  If we will only look, there are ways of seeing things differently. 

As the US car industry discovered, the optics of international comparisons can arm you with effrontery and misplaced confidence.

We are told the NHS is the best in the world.  Is it?  It depends on what you measure and rankings are confusing.  In one list we are 35th.  The Commonwealth Institute say we are the best.  The WHO have other ideas.

We’re the best in the world at generic prescribing, length of stay, not so good.  

The UK has 2.7 beds for 1,000 population, the EU average, 5.2.  Good or bad?  

Some cancer outcomes are disappointing, infant mortality slipping.  

My point is, there is a lot to learn and a lot to improve but apart from the Academy of Fabulous Stuff ,I see no mechanisms or momentum to learn from the best around the world.  

The political narrative is; ‘the NHS will be world leading in this-and-that‘… but with no understanding of how?

Undoubtedly, the NHS has the best system of socialised medicine, but there is a lot to learn and share about outcomes.

An essential part of outcomes is quality.  There is no argument there is an unacceptable variation in NHS quality.  

The quality standards, the NHS works to, are made-up and based on a regime of inspection that has been abandoned by industry since the 60’s and Deming.

You can’t bolt 30,000 parts together and then inspect to figure out which bit is rattling. 

You can’t provide healthcare and turn-up, to figure out what went wrong.

If the NHS could open it’s mind to the world and rethink quality, it could become a learning, high quality, high performing organisation… …then we’d be motoring.

News and Comment from Roy Lilley

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Reproduced at by kind permission of Roy Lilley.