There you are; sitting at the wheel of your brand new Ferrari, California T, listening to the Alpine system giving it up for Nigel Kennedy's 2015 version of Four Seasons.
The climate controls make a baking summer's day a breeze. The engine is singing... zipping along the M1 to Birmingham. Efficiency at it's best.
The problem is you are heading north when you you should be heading south... the meeting is in London.
The Ferrari's 3.9 litre bi-turbo V8engine is at the peak of its performance, the Pirelli P Zeros are whispering, the sound system is concert-hall good... it's all as efficient as it could be. But, it is ineffective, you're going the wrong way.
There is a big difference between efficiency and effectiveness.
He tells us;
'Healthcare is not failing but succeeding, expensively and we don't want to pay for it... so administrations... intervene to cut costs and therein lies failure...'
It's true. We reorganise like crazy, measure like mad, promote heroic forms of leadership and flirt with competition when we really need stability and cooperation.
We pretend the NHS should be managed like a business, when it isn't a business. Managing in a more business-like way is what we should be doing.
Mintburg is also a blogger and has revised a theme he first wrote about in 2014, 2015 and again this month. He thinks it is important to revisit key themes.
I find myself doing the same things; whistleblowing, bullying, protecting the front-line. If issues are important, they are worth a second look and a third...
Mintzburg is back on his theme of efficiency. He says it is like motherhood... quotes Herbert Simon;
'
...efficiency is value-free and a completely neutral concept.'
Efficiency, confused with effectiveness.
Mintzburg asks us; Is a restaurant efficient? Measured in speed of service. maybe. The quality of the food? Subjective. If you don't like curry it'll never be right for you.
Is your house efficient? Energy consumption? Is that why you chose it? Or was it because it was near great schools, around the corner to the railway station or miles away from the rest of the family!
Efficiency is seldom a useful measure. It usually boils down to money. Money usually means cost. Because costs are easy to measure and add up... we muddle cost and effectiveness and wonder why, when things don't go right, we have no idea why.
Money and operating costs are always easier to measure than social costs. Mintzburg tells us, 'efficiency' can mean social costs escalate. Making a school efficient may leave no time for the finesse required in teaching and developing children.
It's more efficient to drive-thro and eat fast food than it is to collect ingredients and turn them into a meal. But, it is nowhere near as good for you.
The ways we measure efficiency are loaded towards the things that are easy to measure. That's why we do it.
In health care; how do you measure a kind word, a reassuring look, a thoughtful gesture, a hand held and precious, final moments shared.
The things that are the most important to patients, facing their fears, and uncertainty, are never measured.
Efficiency in healthcare is not a neutral word. It is a word used to express system values that can be the antithesis of what we want.
It's not the only word. Innovation has been hijacked in the name of savings, cuts and re-organisation. Innovation is risky and the NHS is risk averse.
To be efficient organisations feel they must get bigger, that means other organisations will respond by getting bigger and more bureaucratic. Suddenly the whole system is more remote, less able respond and less effective.
The social values of nearness, peace of mind and moral decision making become the victims of a system that was designed to deliver precisely the opposite.
We reward 'performance' which is almost always defined in economic values; budgets and totals. Mintzberg reminds us, efficient means economising, which means calculating, which means economic goals.
As healthcare is a matrix of providers the economic goals will often compete with each other in efficiency and collectively they miss the central concept, to be effective.
Next time you get the Ferrari out of the garage, be sure you're going in the right direction.
The right direction...
