Let’s think about a word that’s used every day, casually, not valued as much as it should be. Certainly not in the lexicon of management.
It’s a short word and almost invisible but without it, most decision making makes no sense and nothing that is written will ever hang together.
I’ve used the word in these opening paragraphs and you won’t guess what it is.
You’ll over look it… I’ve just used it again.
The word? It’s a bread and butter word… I’ve just used it again.
It is rarely a noun [used in technology], but more often we recognise it as a conjunction.
As a noun, just for the bobble hats; a circuit which produces an output signal only when signals are received simultaneously through all input connections; the AND-gate.
Yes, it’s the ‘and’ word.
As a conjunction; bread and butter. Horse and cart. Knife and fork.
But, there is a better more powerful and potent use for it. For example;
We have a really neat App that allows the user to monitor their blood sugar.
And?
Well, it’s a really neat App and easy to use…
And?
Well, it’s…er… good…
Does it connect with the patient’s health record… no? How is it calibrated and kept accurate… er, dunno? And… what are the outcomes?
Or,
We have added to the capacity of the call centre to answer 999 calls more quickly.
And?
Calls are answered really fast…
Does it get more ambulances on the road, give us more paramedics, er… no? Does it back-calls-up, that we can’t get to?
Err… probably…
‘And’, is a conjunction. It joins things up; words, ideas. It cannot be left incomplete. It can’t be left unresolved.
If there is a this, there has to be a that… this and that.
To resolve ‘and’ means we have to link things up. What’s next, what are the consequences?
Used in management speak, it provides the same function. It makes us join things up.
‘We are setting up diagnostic units’
And?
They are very modern and quick and give excellent images…
And?
... err, the patients love them…
… do we have the skilled staff to operate them? And, if we increase our capacity to diagnose conditions more quickly, do we have the capacity to treat them more quickly?
‘And’, used in this context, forces us to look at the patient pathway as a supply chain, ‘and’ forces us to look beyond the change or innovation we are dropping into the system.
It’s easy to mesmerise ourselves with a new thing or project. ‘And’ forces us to think about what our new thing, or idea, actually does… or doesn’t.
‘And’ makes us ask not just what the impact is but how it will reverberate across the system.
‘And’ is the ultimate open question.
Closed questions, we don’t want. ‘Do you want a drink?’ ‘No thanks..’
‘Did you go to the meeting?’ Closed question. The answer is yes or no.
Throw-in an ‘and’ and you get; ‘… it was chaotic, badly chaired, over-ran and we decided nothing’.
‘And’, repeated, turns a closed question into a funnel-question, narrowing and drilling down.
And?
‘…we decided nothing’.
And?
‘We are going back again next week and in the meantime, we will be sent more data…’
Better questions get better answers.
Questions are asked for three reasons;
- the question is important,
- the answer is important,
- what the question reveals, is important.
Rarely, the first answer is the one you are looking for.
Curiosity or inquisition? The way questions are asked is important.
When a doctor makes a mistake, there is an inquisition. Livelihoods, professional standing, careers are threatened. The process can take years and people clam up. Often the truth is never discovered.
If, when a doctor makes a mistake, we are curious, we learn more.
‘I made a mistake’.
And?
‘I confused a dose… I administered a treatment wrongly… I was so tired, I got muddled…’
It’s only then we can start to learn. Prevent it from happening next time.
There are universal questions that managers routinely apply in any business, service or sector. They are; what, where, when, why, who, how, (how much), what if?
Add to that list, ‘and’…
… and you have a way to unroll, unpack and lay out what you know, what you don’t know and what’s the upshot.
There once was a furniture store, that sold tables. Not very many.
‘We can’t sell tables,’ said managers. Why? ‘They won’t fit into a family car’
And?
‘People have to unscrew the legs to get them home… and they can’t be bothered’
And?
‘We could deliver…’
And?
‘That would put the price up.’
And?
‘We could do it for them; take the legs off, make the tables flat pack, with the screws and instructions, to assemble them at home…’
And… …that was how Ikea was born.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
