Tag Archives: evidence-based

Scan gel can teach us a great deal about EBM

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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.

For personal development linked to this topic visit the Consummate Professional Series

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Why the CIPD is desperate for evidence.

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Credible evidence is a real problem for the very body that exists to maintain the highest professional standards – the CIPD (Chartered Institute of Personnel & Development).  Jackie Orme, Chief Executive, declared that ‘there have never been enough good people working in HR’ and the CIPD Board, in buying The Bridge Partnership in 2009, tacitly admitted they do not possess the requisite credibility, capacity or capability either .  So in one fell swoop the chartered, ‘professional’ body has written itself off along with the expertise, skills and experience of its entire 130,000+ membership. Meanwhile it is creating something called “Next Generation HR” (for an update on how this is doing see here) with a ‘thought piece’ that is totally devoid of any coherent thought and without a single, new idea to distinguish it from whatever ‘last generation HR’ was.

So what is “Next Generation HR” and what is so exceptional about The Bridge Partnership that led the CIPD to seek it out in an attempt to bolster its own credibility?  How would the objective observer know they are not just another bunch of psycho-babbling charlatans?  A visit to Bridge’s website says it “harnesses strategy, business insight and psychology to breathe leadership and new life into organisations.” – something the CIPD definitely needs.  However, the one thing on which credibility is built – evidence – is conspicuously absent.  So ‘Next Generation HR’ practitioners are unlikely to be any more evidence-based than their conventionally-trained predecessors.

Having a professional body run by evidence-based professionals is the only way out of this impasse: so how are the Board members of the CIPD currently performing against this higher standard?*

  • The current Chair, Dean Royles, is Director of Workforce and Education at the North West Strategic Health Authority of the NHS and controls a budget of £650 million and yet, according to his own ‘Education and Learning Strategy’ he openly admits that “Organisations will need a better understanding and application of educational evaluation methodologies to appreciate the impact of education and learning activities.”  In other words, he accepts the principle of evidence-based practice but does not know how to produce the evidence required.
  • Another Board member is a past president of the PPMA (Public Sector People Managers Association), Stephen Moir, who as Director People, Policy & Law at Cambridgeshire Council has produced an HR strategy with all the latest buzzwords (“employer of first choice”, “celebrate diversity”, “competence framework”) but no sign of an evidence base for these policies.
  • Then there is Gill Rider**, holding potentially the most influential ‘HR’ job in the UK Civil Service as Head of Profession, who has not provided any evidence that she is making any progress after four years at the helm.

The rationale behind this site therefore is a vision of a future in which HR and learning professionals earn their rightful place alongside the medical profession in terms of evidence-based best practice and alongside senior operational managers in terms of management expertise. In fact, as the concept and practice of evidence-based management is currently challenging all management functions, evidence-based HR professionals do not need to make any apologies while they learn how to get up to speed with this new way of thinking.

Let no one be under any illusions though.  If HR and learning practice is not already evidence-based it won’t suddenly become evidence-based overnight. Evidence-based HR is primarily about high impact, strategic solutions to difficult organisational issues and requires cooperation from everyone involved; it cannot and should not be imposed by, or reside exclusively with, the HR team.  So, for example, if Dean Royles wants an evidence-based, quality assured learning system in the NHS, the first thing he will have to do is learn about evaluation, re-visit expensive schemes such as his Leadership Academy and make a conscious decision to build it on a solid foundation of evidence-based practice.

Alternatively, he should call a halt to wasting huge amounts of money on an edifice that cannot produce any evidence that it represents a sound investment.  There is no room any longer for hype or psycho-babble in this new, evidence-based management (EBM) universe.

*The issues outlined above have been raised directly with the CIPD Board members referred to before publication – to date no responses have been received but they have another opportunity here to respond to these challenging questions.

**Update June 2011 – After 5 years at the helm Gill Rider left the Cabinet Office having only “concluded the development phase” but predicting”anticipated savings of £300 million and a best in class staffing ratio of 1:100.” After such impressive results it is no surprise to hear she has become CIPD President.

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