Taylor, Ford & management

If you cast your minds back to the early twentieth century, there was one company and one product that was about to revolutionize transport and communications: Henry Ford's Model T.

I have heard it said that Henry Ford was influenced by the ideas of Frederick Winslow Taylor, the first of the management consultants. Taylor's theories on "scientific management" have become the foundation of many Masters in Business Administration (MBA) courses. But why does this concern those interested in healthcare?

Taylor believed that a worker playing sport would "[strain] every nerve to secure victory for his side" but that "[when] that same workman returns to work on the following day, instead of using every effort to trn out the largest possible amount of work, in a majority of cases this man deliberately plans to do as little as he safely can - to turn out far less work than he is well able to do - in many instances to do not more than one-third to one-half of a proper day's work". In this, Taylor seems to believe in the fundamental laziness of workers - and indeed, the laziness of all but the most senior of managers; it becomes the role of management to drive the workforce with incentives, slogans and managment-by-objectives (MBO).

Nelson & Deming believed that this view had created a prison limiting both the senior management and the rest of the workforce, with "comments overheard in the prison compound" such as:
* "Computerize everything, let's eliminate people"
* "Let's appraise performance and get rid of those below average"
* "Don't tell me how you do, just do it"
* "Just give me the bottom line"
* "With a good MBO system we only need to set targets for people"

Therefore, if management can just set up a series of procedures and ensure that all follow them, quality will ensue. Particularly in service organizations - such as the NHS - there is the (unstated) assumption that there are fully defined and followed procedures. Unfortunately this is often not the case.

Often we compound the problem with inspection - generally 'dependent' inspection, reviewing work after it has been completed. This in less effective than one might imagine. It also puts the emphasis in the wrong place: work on improving the process instead.

So what is the alternative? What can we learn from successful companies? (Worth listening: saying "our (healthcare) problems are different" may limit what we can do.)

One of the pople who attended Deming's lectures in Japan after World War II was Konosuke Matsushita, the founder of Panasonic. Reflecting on the difference between Japan

“We are going to win and the industrial west is going to lose: there’s nothing much you can do about it, because the reasons for your failure are within yourselves. Your firms are built on the Taylor model; even worse, so are your heads. For you, the essence of management is getting the ideas out of the heads of the bosses into the hands of labour. We are beyond the Taylor model : business, we know, is now so complex and difficult, the survival of firms so hazardous in an environment increasingly unpredictable, competitive and fraught with danger, that their continued existence depends on the day-to-day mobilisation of every ounce of intelligence. For us, the core of management is precisely this art of mobilising and pulling together the intellectual resources of all employees in the service of the firm. We know that the intelligence of a handful of technocrats, however brilliant and smart they may be, is no longer enough. Only by drawing on the combined brain power of all its employees can a firm face up to the turbulence and constraints of today’s environment”

Further reading:
Latzko WJ & Saunders DM (1995) "Four Days With Dr Deming"
Labovitz, G, Rosansky, V & Chang, YS (1993) "Making Quality Work: A Leadership Guide for the Results-driven Manager"