The ‘Spaghetti notes’ phenomenon

Most people I know like pasta. I don’t. I find it bland and boring (sorry Italy).

I find spaghetti particularly annoying. No matter how much I eat, the portion in my dish never seems to reduce. It gets all tangled on my fork, it dangles everywhere, and it makes a big mess.

Which is a nice segue to this post:

The more ‘functional’ (i.e. specialised/ compartmentalised) a service has been designed then…

…the more likely that a client must speak with lots of different people (‘a new person every time’)

and the more likely that the client’s needs are then broken up into ‘transactions’ and passed on (a.k.a ‘referred’) to lots of other people to work on…

…the more people ‘touch’ (i.e. work on) a client record…

…the more file notes are left on the client record…

…the harder it is for someone working on a client record to work out what is going on…

…the more likely that, during a client interaction, the person attempting to help can’t possibly read ‘all the notes’ and so only reads what is obvious to them in the time (that they feel1) they have available to them…

…the more likely that something important is missed from within the notes…

…the more likely that inappropriate/ incomplete actions are taken and, worse, serious errors are made…

…the more likely that a client needs more work done2 on their record (to deal with the resultant failure demands, to ‘undo’ the actions taken, and the knock-on effects)…

…the more likely that a ‘leaving good notes’ policy is rolled out (including ‘best practice note templates’ and ‘quality control’ by inspection of note taking)…

…the more time taken by everyone working on a client record to make detailed notes (and to ‘police’ this)…

…the more involved each note becomes…

…the even harder it is to work out what is going on (because there’s yet more notes and each one has become painful to read – even containing internal hieroglyphics to supposedly make an ‘easier to consume’ short-hand)…

…until we arrive at the ‘spaghetti notes phenomenon’ where it’s virtually impossible to know, let alone understand, what’s gone on when viewing a client record, and it would take days of effort from a dedicated and experienced worker to review all the notes and patch them together into a coherent whole…

…and if they do this, they will stand back and think “oh my @%&!, what a pile of waste it took to achieve a shite client experience.”

 

The final ‘nail in the coffin’: Someone helping a client can often look at the spaghetti before them in the client record and (rationally) arrive at the conclusion that it would be much easier to ignore all the notes and talk to the client as if they are starting all over again.

 

Reflection:

Focusing on making good notes is an example of single-loop learning (‘making a wrong thing righter’).

The real problem isn’t with the notes, it’s with the design of the system that means that so many people are working on the same client record, because it’s this that creates the spaghetti.

 

Clarification: I’m absolutely NOT against good notes – if I’d worked on a client file a month ago, I’d like to read my own note that effectively and efficiently reminds me where I left off. I’d also like any colleague to be able to read it and gain a similar understanding.

What I AM against is a system design that causes a ‘note making’ reinforcing feedback loop3.

 

Footnotes

1. A person helping a client could take a great deal of time to work through the notes – to make sure that they gain the necessary understanding – but does their working environment cause them to think that this time isn’t available to them?

Do they feel like they’ve got to get through x number of tasks today and so time is of the essence?

2. And, of course, this ‘more work’ needs yet more notes adding to the client record.

In my experience, a ‘here’s what we did to undo an error’ file note is a convoluted thing to read (let alone write), and almost impossible to follow because ‘you had to be there’ to actually get it…which means that such file notes are often glossed over because it’s easier to do so…which leads us back around into the same torturous circle.

3. For those readers that may not understand what this means, a reinforcing loop is one in which the result of an action produces yet more of the same action, thus producing growth (or decline depending on which direction the action in question is leading).

“Citizens face many front doors…”

Doors-Doors-DoorsGovernments all over the world want to get the most out of the money they spend on public services – for the benefit of the citizens requiring the services, and the taxpayers footing the bill.

Government officials regularly devise initiatives, and even new departments, aimed at getting their myriad of agencies to work better together.

However, looking at this from the outside, the media regularly uncover seemingly daft (and sometimes tragic) instances where government agencies have failed to effectively act, connect and co-operate with each other. In such instances, each agency appears to ‘the person on the street’ to have been wearing blinkers with their ‘common sense’ radars turned to ‘exceedingly low’.

But is it right to lay blame on the agencies or, worse, the people acting within them? In the majority of cases, I’d suggest that the answer would clearly be ‘no’. We should be looking at the bigger ‘whole of public service’ system that they are designed to operate within.

A new phrase was termed some years back called ‘Joined up government’. The Oxford dictionary defines it as:

“A method of government characterized by effective communication between different departments and co-ordination of policies.”

When a dictionary defines a word, it usually provides the reader with an example sentence showing its proper usage. In this instance, the first example sentence given is a negative one, as in:

“There is an obvious lack of joined-up government here” (Oxford Dictionary)

i.e. Governments openly recognise that there is a big problem (a lack of togetherness)…and that they would love to ‘solve’ it…but it’s regularly in the ‘too hard basket’!

The purpose of this post is to share (what is to me) an important (and very well presented) 30 min. video by Jeremy Cox1: Budget Management and People Centred Services that nicely explains, by way of reference to a real case study, the ‘multi agency’ problem and how to go about changing it.

If you are interested (particularly if you work within the public sector) then I’d expect that watching it should be a worthwhile (and thought provoking) use of your time.


Right…if you’ve got to here then I’ll assume that you’ve watched the video…the rest of this post pulls out (what I believe to be) key things said by Jeremy Cox in his presentation (blue italics below) and my ‘wrap-around’ narrative.

Note: What follows is incomplete and not a substitute for watching the video. It’s just an aide-memoire so that I (and you) don’t have to watch the video every time to pull out the key points or discuss it with our colleagues.


Jeremy Cox starts at a summary level by walking us through “four critical steps”:

1. The first thing to do is to study your system…and, just to be crystal clear, YOU (those responsible for the system) have to study it, and do so WITH those who operate it. A consultant cannot do this for (i.e. to) you2.

“You have to go and study because if you see it with your own eyes, you can’t deny it. If someone ‘tells you’, then you can ‘rationalise’ it away quite easily.”

2. From studying your system, you can then see and understand the effects of (supposed) ‘controls’ on its performance.

3. Only when we understand (at a root cause) WHY the system operates as it does, should we redesign…because then, and only then, is such a redesign based on meaningful evidence…as opposed to the usual ‘conventional wisdom’ or ‘current in-vogue ideology’;

and finally:

4. Devise new measures, and move to a new model of leadership.

Cox then goes into each step in some detail.

Going back to Step 1: Cox talks about studying demand.

HelpHe takes us through a case study of a real person in need, and their interactions with multiple organisations (many ‘front doors’) and how the traditional way of thinking seriously fails them and, as an aside, costs the full system a fortune.

Understand demand in context….don’t understand people from the point of view of your organisation, understand the person and what matters to them about living a better life.”

The case study is sad…and yet not really a surprise – we all kind of know that it’s true. It shows the huge power of following some cases around the full system.

In explaining Step 2, Cox opens up the madness within silo’d (i.e. single department) thinking, which is driven by their ‘budgetary controls’.

Rules of playHe identifies three survival principles in play, and the resulting anti-systemic controls that result:

a) “We must prioritise [our] services for the most in need” which leads to attempts to stop entry into the service, and then the requirement to break through escalating thresholds of eligibility.

Such ‘screening out’ logic creates the following madness: “Your case isn’t serious enough yet…go away until things get worse!”

b) “We must stick to what we do” which leads to “I can see that you need A and B for you to get better…but, here, we only do A.”

Cox gives a real example of an alcoholic with depression being turned away by mental health practitioners because “we don’t work on alcoholism – you need to solve that first and then come back with your depression”. We can predict that such unhelpfulness will lead the needy citizen towards a rather large drink!

c) “We must limit service delivery” which leads to attempts at closing cases, doing things on the cheap, and setting time limits…all of which are about pushing things through at the expense of the needy citizen…which will lead to failure demand (probably popping up unexpectedly in another department…and therefore not seen as linked).

The redesign at Step 3 requires different principles.

IntegratedCox makes the obvious point that the actual redesign can’t be explained up-front because, well…how can it be -you haven’t studied your system yet!

…but, generally, it is likely that “genuinely integrated, local-by-default problem solving teams will emerge from [following the steps]”.

A clarification: ‘Genuinely integrated’ doesn’t mean a multi-disciplined shared building where people regularly come together for, say, case review meetings…and then go back to their ‘corners’ and work to their existing (i.e. competing) policies and procedures.

A nice test from Cox:

“How do you know a team is genuinely integrated rather than co-located?…All you have to do is look in the fridge – nobody’s written their department’s name on the milk!”

And so to Step 4: New measures and new leadership

shovelling sand with a pitchfork[Once you’ve successfully redesigned the system] “The primary focus is on having really good citizen-focused measure: ’are you improving’, ‘are you getting better’, ‘is the demand that you’re placing reducing over time’.”

Notice that these measures are about the purpose of the system (i.e. for the citizen), and NOT about the activities performed within the system. It’s not about the volumes of calls taken or visits performed or payments made or cases closed or…[carry on naming activities].

“You have to shift leaders from managing the budget top-down to adding value to the process of studying, and improving outcomes for individuals.”

The point here is that you are never done. The outcomes from a redesign can radically shift performance, but you’ll quickly be ‘back at square one’ if you haven’t grasped the WHY and don’t ‘kick on’ to yet more learning, and yet more improvement – becoming better every day – for the good of citizens, and (importantly) for the pride of your employees.

To close

What’s most interesting to me from the video is the graphic explanation of one unit of demand, a needy citizen in a really shitty situation, being bounced around – presenting at public service ‘front doors’ in multiple and seemingly unrelated ‘cases’, with each agency doing what they can but not what is required….and the needy slip ever further into their personal quagmire.

“We limit what we do to ‘what we do’, not to what the person needs.”

Cox makes the hugely important point that, once you open your mind, then the study and redesign of the work is relatively easy. The hard bit is re-conceiving the ‘system of management’. This takes real leadership and (perhaps most importantly) self-development.

Cox closes with the following comment:

“Some of the most rewarding work that I have ever done is just working with these integrated teams who are out…on the ground, with good leadership, learning how to solve problems for citizens. You actually see people’s lives turned around and people who otherwise would have been dead who are now still alive.”

This is powerful stuff! There can’t be much more meaning to anyone’s working life than that.

Footnotes:

1. The video covers one session within a ‘Beyond Budgeting’ event run by Vanguard Consulting over in the UK. The first 3 mins. is an introduction from John Seddon, and then Jeremy Cox (a Vanguard consultant) presents the rest.

Note: Cox refers to names of UK government departments (e.g. The DWP). If you live elsewhere in the world then you are likely to have similar agencies, just with different names.

2. A consultant cannot do it for you: I should clarify that an experienced ‘systems thinking’ coach CAN facilitate you through studying your system and its redesign….BUT they aren’t ‘doing it’ – you are!

I have a post with the ink half dry that explains and expands this point called ‘Smoke and Mirrors’. I guess I should get on and finish it now.

3. The NZ government is setting up a Social Investment Agency. Its focus is fundamentally about changing the lives of the most vulnerable New Zealanders by focusing on individuals and families, understanding their needs better, and doing more of what is most likely to give the best results”. I like the intent.  I hope that those involved watch (or have already watched) the Jeremy Cox video, and consider the messages within.

Enough rope to hang ourselves

NooseIf you pick up a shiny new thing, perhaps a tool or methodology but don’t have a true understanding of the underlying thinking….then you’ve probably just found yourself with enough rope to hang yourself.

Note: I don’t put myself above being at risk of suffering this condition 🙂

Take John Seddon’s failure demand concept, which is explained in this earlier ‘marbles’ post. Once you’ve (re)read it, you will see that the failure demand concept is REALLY easy to understand and potentially incredibly powerful. In fact, it causes ‘light bulb’ insight moments.

But wait, don’t rush off just yet. Why do we get the failure demand?

Oh, too late, someone’s rushed off…

John Seddon uses the example of a senior civil servant in the UK Government finding out about the failure demand concept and (using their existing command-and-control mentality):

  • a) mandating that local authorities will, from now on, collect and report (to central government) on failure demand using a standardised method; and then, once this was in place
  • b) setting targets to reduce it, likely putting in place ‘performance incentives’ for successful reduction…which then require the judging of people’s performance .

So, what do you think would happen?

Well…

  • Step a) causes under-reporting of failure demand. People start off very cautious and don’t like exposing it to a command-and-control hierarchy that jumps to blame and usually then goes on to dictate ‘solutions’;
  • Step b) causes the reporting of only the failure demand that they believe can be reduced or removed within their control….so that they can then show great success against the set target and gain the rewards on offer;
    • …which hides the most important cross-departmental failures;
    • …and means departments throw work over the fence to other silo’s (moving rather than removing the problems) and arguing between each other as to who is claiming what benefits;
    • …which leads to the ‘centre’ (policy dictators) to introduce controls and auditing of the results to catch ‘cheaters’ (which requires new work, requiring resource…which is waste)

Therefore the data collected is incomplete and distorted whilst the initiative looks really successful, paying out incentives for things that could easily be achieved anyway. Yet the system hasn’t changed, much of the failure demand remains hidden and much energy (and money) has been spent in wasteful activity.

Looking at this, what is the knowledge that was missing?

They didn’t stop and think to study why the failure demand was occurring. They jumped to use their existing management thinking in the hope of quickly ‘solving’ it.

A huge caveat: To remove waste, you need to understand its causes”.

“Treating improvement as merely process improvement is folly; if the system conditions that caused the waste are not removed, any improvements will be marginal and unsustainable.” (John Seddon)

If they had studied their system, they would have seen the effects caused by:

If they understood their system, according to its purpose (from the customer’s point of view) and then designed it to allow the people within it to understand its capability (NO targets) and then collaborate across its components (No contingent rewards) to experiment with improvements….then they can successfully identify and remove failure demand…with no need for the waste of monitoring.

Moving on to waste:

Many organisations do the same ‘enough rope’ trick when it comes to waste.

They are taken through Taiichi Ohno’s 7 types of waste, with the 8th waste of untapped human potential added for good measure.

Each waste is explained, with examples, and some really good ‘class room’ understanding is achieved. Some of the more tricky waste concepts (like inspection and transport) take a bit of time to cement into place….but people ‘get it’.

…and so they are off, with their ‘waste spectacles’ donned, looking for waste.

But it goes awry when objectives (with targets) get set around waste reduction, and rewards are tied to achieving this. Management become waylaid with the categorising and reporting on the waste. They have now entered the same ‘existing management thinking’ game as is described above.

To be clear, Ohno didn’t want waste to be classified and reported, he wanted it to be removed. His reason for setting out 7 types was only to assist in spotting it….it is waste to spend your time categorising and reporting on waste!!

What you actually need to do is understand the root cause: why is the waste occurring…and this is far deeper than the process. It usually comes down to the current management thinking (which is rooted in management’s beliefs and behaviours).

Then, and only then, can you actually remove the waste.

Here’s a John Seddon quote that is worth taking some time to ponder:

“Fads and fashions usually erupt with a fanfare, enjoy a period of prominence, and then fade away to be supplanted by another. They are typically simple to understand, prescriptive and falsely encouraging – promising more than they can deliver. Most importantly, fads and fashions are always based on a plausible idea that fits with…management’s current theories and narratives – otherwise they wouldn’t take off.”

Don’t let failure demand and waste become ‘fads’ – they are not. They are very real things which drastically harm an organisation’s ability to meet its customer purpose…but we need to go deeper and understand the why, why, why.