A number of years ago I worked for a South Wales manufacturer of steel rod. The company was interested in learning how the Japanese were more productive in steel rod production and so sent a delegation from the factory to their Japanese counterparts. They received a Japanese delegation in return. My client was hoping for a simple solution to the productivity problem. It turned out to be far more nuanced. Both factories produced steel rod in a similar way. However, there were numerous small ways in which the Japanese were more efficient. They fine tuned the temperature of the furnace. They kept the furnace door open only just enough to allow the hot billet to exit whereas the British company flung the door wide open.
I have been reminded of the conclusions of this exercise many times in subsequent years. There is seldom one single issue that is the cause of a problem. At least, if there is one single issue it almost always is identified and dealt with. Of course, managers look and hope that there is just one thing that needs rectifying. Life would be much simpler if this was the case.
Take the problem that the NHS is facing right now. There isn't a single cause. There are problems with primary care and GPs. When the NHS was first set up GPs dealt with most medical problems whereas today patients are more readily shunted into the hospital system. We have an ageing population, living longer and more concerned than ever about health issues. This puts a huge pressure on the NHS. And then there is social care, the Cinderella of the health system which finds it difficult to cope with the volume of discharges from hospitals.
All these problems can be identified and dealt with. But what if there is a more significant underlying problem. What if the real problem is that we haven't sufficient managers? This may seem counterintuitive as we would almost always believe that a better investment would be made in medics and machines. Contrary to popular opinion the NHS has the lowest administrative costs among comparable health systems. OECD data estimates that the UK spends 1.2% of its current health expenditure on NHS administration versus an OECD average of 3%. More and better managers may be able to run the system more efficiently, liaising better with GPs and easing the transfer of patients into the care system. Those of us who have used the NHS recently or have spoken to people who have been there, will hear stories of how there is considerable waste with repeated tests, cancelled appointments or simply a lack of regard for wasting of time.
The point of this blog is to emphasise the need to look beyond what might seem an obvious solution. It is a reminder that complicated problems usually have complicated answers and we should be prepared to dig deep and look beyond the obvious.