Rubbish

Whose job is it to put out the bins?

Is it a man job, or a woman job? 

A blue job or a pink job?

Ouch… careful!

Indesit, the white goods manufacturer did a very interesting study. 

They revealed that men are still in charge of taking out the bins and clearing out the drains, while women take charge of the washing up, laundry and cleaning the toilet.

They called it the ‘Chore Wars’. 

‘… from the 2,000 adults, surveyed: 85% of women claimed to be solely responsible for delegating household chores. 76% of women suggested they carry out all domestic jobs, including cleaning, tidying, gardening and some DIY.’

How are you getting on with the chore-wars in your household? 

It’s nice to know that someone spent time and money studying them! You can get a Phd in most anything these days!

Not quite who empties the bins but what is in them, stuff thrown randomly together, back in 1972…

… was used by three management gurus, Cohen, March, and Olsen to describe the ‘Garbage Can Model’ of decision making.

They described a chaotic and unpredictable process where problems, solutions, and decision-makers are loosely coupled, essentially ‘thrown together’ like items in a garbage can, leading to decisions being made based on what happens to be available at what they described as the ‘Choice Opportunity’…

… rather than a structured evaluation process.  

They illustrated decision-making in an ‘organised anarchy’ where goals and priorities are often unclear.

The Garbage Can Model challenges traditional, rational decision-making and instead suggests that organisational decision-making is often chaotic and influenced by three independent streams:

• Problems; Stuff that needs fixed.
• Solutions; Ideas and answers looking for problems to solve, typical of the IT brigade.
• Participants; Individuals with varying degrees of involvement.

Put them together and that creates Choice Opportunities; giving the organisation the opportunity to arrive at decisions.

It’s not quite as bonkers as it seems. Organisations, however well-led, are often chaotic. Not necessarily disordered but certainly buffeted by time and events.

Health care is highly ambiguous and takes place in a complex environment where decision making isn’t always linear. Chaotic? Let’s hope not but certainly opportunistic…  

… put politely, responding to the influences around at the time. For example, the chaos created by the electoral cycle.

To deal with that, we could create an environment where ideas and solutions can… intersect organically… meaning, like the stuff chucked into the bin.

Apply the Garbage Can model to the problems of the NHS?

There are variable factors; funding constraints, staff shortages, and increased demand. These problems exist independently, waiting for individual attention. In so-called silos.

The obvious solutions, more money, outsourcing, digital-something-or-other… float around, like the rubbish in the bin, without any real prospect of alignment.

Innovative ideas such as AI-driven patient-triage or community care models all exist but lack implementation due to bureaucratic hurdles, or lack of innovation, leadership…

… or alignment, in the bin.

A diverse group of stakeholders; sharp-end staff, managers, policymakers, and patient groups, will complicate things by each having different priorities and levels of influence.

Involvement is often inconsistent and decision-making depends on who is present at the time. 

Quite often political influences, public pressure, and media attention can shape the to-do-list. Much like the pressures we are experiencing now.

What emerges are moments when decisions are made. Such as when government funding announcements are made, policy announcements, or system pressure crises.

This is when ‘choice opportunities’ emerge…

…where issues come to the forefront and solutions often hastily applied during these windows, without a strategic approach, leading to short-term fixes rather than systemic-change.

The Garbage Can model explains;

With the random alignment of factors (chucked in the bin), solutions may not always address the real, pressing challenges but rather the ones that happen to align.  

Policies and strategies often emerge in response to crises rather than through long-term planning. Decision-making processes become overwhelmed

The garbage can is a daily domestic task and a daily reality for decision makers in the thick-of-it. Recognising that means using it to advantage;

Create more Choice Opportunities: Increase the frequency of review processes where solutions can be regularly considered and alignments created.

Encourage collaboration: By fostering regular interaction between the parts, ambulance, Trusts, primary, social and community care.

Simplify decision pathways; prevent promising solutions from being lost in the system. 

Use garbage can to avoid making decisions that are rubbish.

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.