As someone who has often taught the ‘Toyota Way’ as a (very rare) case study of exemplary HR Strategy, the recall of thousands of its vehicles in 2010 serves as a stark reminder (not that I needed one) of the severe limitations of case studies as teaching aids.  The world can change so very quickly that it renders case study material irrelevant or just plain wrong. Whether or not these recalls should be seen as evidence of Toyota having got something fundamentally wrong or not, my informed guess is that Toyota will learn how to overcome this latest hurdle and remain at the forefront of the automotive industry, if nothing else simply because it has nurtured evidence-based habits in its people over many, many years.  Nevertheless, it just goes to show that no organisation, however successful today, can afford to become complacent. So what has all of this got to do with a tube of scan gel? (you know that stuff they smear over pregnant bellies to check the baby is OK?)

Some years ago a workshop delegate told me a story about how Toyota was so good at continuous improvement that it had reached a stage where an employee invented a plastic pencil-stub-holder to hold the old-fashioned pencils Toyota still used (they still regard pencils as ‘fit for purpose’).  The stubs were what was left after sharpening the pencil down to its last inch or so (2.5 centimetres).  The cost of the re-usable holder was seen as a worthwhile investment in terms of lower pencil costs.

Now you might not see this as clear evidence of very sophisticated management thinking and practice.  In fact it might appear like the very opposite; management declining into a sad state of obsessive, micro-management.  Can an organisation as big and as successful as Toyota really be that bothered about the cost of a new pencil? Haven’t they got more important matters on their minds?  Have they brainwashed their employees to become obsessed with minutiae? Well, whether you see this as an indictment of the modern world’s drive for perfect efficiency or not, if we ask the same question about healthcare costs perhaps it puts it into perspective?

Anyone who has ever seen a scan being performed will know that the scanning clinician will squirt a sizeable dollop of scan gel on the area to be scanned; to ensure a clear image is achieved. It suddenly occurred to me once that the clinician did not measure out a precise amount of gel and, with 60 million potential patients in the UK alone (and scan gel selling at nearly $30 per US gallon) that might amount to quite a lot of unnecessary gel being wasted.  So is this simple procedure a suitable case for considering the merits of evidence-based HR management or am I just a sad so-and-so who has nothing better to do than annoy hospital clinicians?

The evidence-based manager’s answer to this question is quite simple -we don’t know until we look at the evidence and the EB manager willingly admits their initial ignorance. Until we know how much scan gel is used each year we have no basis for deciding whether this is a priority or not. For all we know the potential saving from a precisely-measured application of  gel could be anything from £10 to £10 million per year in an NHS that spends £120 billion per annum  . So the first step for the E-B manager is to assess the cost but that immediately poses a long list of other questions: -

• Do we have any precise data on how much gel needs to be applied in different scanning procedures?
• Does the NHS ensure that all scan gel purchases are coded identically in the accounts?
• Does the NHS know how and where all the scan gel is used?
• If it knew all of this, at what level would it be able to track the use of scan gel – by hospital, department, team, shift or individual clinician?

I posed this very specific question to a group of very senior NHS managers (up to Chief Executive level) only last week and was advised that the data should be available down to department level. I suggested that only when we reached down to the individual level would we be able to speak to individuals about their own personal use of scan gel. I got the impression (without implying any criticism) that this was not likely to become a major priority overnight – which is precisely the point – managers and doctors cannot manage everything themselves.  Evidence-based management is as much about self-management as it is about senior management.  My humble guess is that, among the 1.3 million workers in the NHS, the laws of probability suggest that at least one clinician has calculated the precise amount of gel required to produce a clear image at the lowest cost.  Not because they are sad individuals but because they are totally dedicated to providing the absolutely best (fit for purpose) value the NHS can provide and they know that money wasted on scan gel cannot be spent elsewhere.

Now all the evidence-based HR manager has to do is find out where these people are and create an environment where they can teach some of their colleagues how they do it.  Of course, the key to this is actually a long-term HR strategy which genuinely aims to engage every single employee in the pursuit of perfect value for money.  If we do not explicitly and systematically encourage such a positive approach, every day of the week, it is almost impossible to engender the requisite level of commitment just as times get hard. No doubt the list of similar savings opportunities is probably endless but the evidence-based manager also realises what impact structure and culture have on an organisation. Would the clinician be allowed to use his or her own best judgement on the amount of scan gel used or would it become a very long and tortuous process of evaluating various methods; all subject to scrutiny by senior consultants? Who knows, but asking scan technicians to show some interest in the subject by providing comparative data on their own usage might be a start?

Maybe evidence-based management is not really about pencil stubs or tubes of scan gel at all, more the means by which every single employee is enabled, encouraged, allowed and supported in working to the very best of their own ability? It is also about suppliers educating customers how to get the most value out of their products – but that is a subject for another day.

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