One day Brian emailed me with a lead for me. It was a care home. He couldn’t be entirely clear what their problem was, but they had said they needed a time and motion study and, did I do those?
Well, my response to that (as ever) is to assume that, whenever somebody tells me they have a problem, all I know at that stage is that that is not what the problem is.
But since, in principle, I could deliver a time and motion study if the lack of one really was the care home’s problem, I agreed to meet the owner.
After a number of calls to him, it was agreed that I would visit the home and discuss the issue with one of his senior managers. And I duly did this.
I should add straight away that there was no problem with the quality of care the home provided—its rating from the regulator, the Care Quality Commission, was ‘excellent’; nor was occupancy an issue—it was full.
However, there clearly was an issue that could be clearly stated: a few years previously, the core team of carers was able to complete all of its required tasks. But now—even though the team was a third larger, and almost all the team members of three years ago were still in the business—the core care team was unable to complete all the tasks and was crying out for more people.
The home management had a problem. If there was an unannounced visit from the regulator, the home risked losing its CQC rating, which could have disastrous reputational consequences. But to ensure the core team was adequately manned would require an apparently permanent increase in headcount without any increase in income, the home already being full.
Maybe, it’s no surprise that the owner diagnosed the problem was that they needed a time and motion study. After all, if people aren’t working efficiently, let’s analyse how they could work more efficiently if they worked differently. But, in truth, that was actually the owner’s wellmeaning attempt to define a solution to a problem he hadn’t fully defined.
So, I had a meeting with one of the senior managers. My first line of enquiry was to establish, whether, in fact, the care team actually had a greater workload than three years’ previously. It turned out they did, due to additional requirements made by the CQC in 2010. But the increase was nothing like the increase in staff numbers available to do the work, so we looked elsewhere.
In discussing the care team’s performance, it became apparent that the care team had become disaffected and demotivated. Now, when people are demotivated, it is usually the case that their performance and productivity drops. So, that seemed a useful line of enquiry. Had there been anything to account for the demotivation? Well, it turned out that the carers didn’t like the extra administration the CQC demanded.
But was that enough of an explanation? I doubted it though I didn’t have any evidence. But, it would have been careless of me not to carry on and it became interesting that there clearly was something else ‘wrong’, but this manager was unwilling to tell me what it was. It was as if it was ‘confidential’ or even embarrassing, or even shameful. It took me some time to get at the truth, by patiently exploring around the edges of the problem.
Eventually, when I had gained the manager’s trust (she had, after all, only met me an hour earlier), she spilled the beans.
Three years ago, there had been a different owner. The old owner was very ‘hands on’, and could always be seen doing stuff around the home. Personally, I think being up a ladder fixing the guttering was taking that ethos too far but there was clearly no denying the fact the carers believed he was committed to the home and to the people working in it as well as to the residents. They were motivated and they worked well.
However, the home now has a new owner. The new owner is the opposite of the old. Often offsite without warning for unpredictable lengths of time, it was if he felt he had better things to do. Indeed he wasn’t there when I visited. As a result, the care team became disenchanted. What was a good thing—a high staff retention rate—turned out to be a problem because all the people who had been there three years ago were still there, so it was only too easy for them to make comparisons.
The team’s disenchantment and demotivation turned into reduced efficiency which turned into the presenting problem of them not being able to finish their allotted tasks in time. A time and motion study, far form being an appropriate intervention, would actually have appeared to be calculated to create the maximum irritation and demotivation: implying, as it would, that everyone thought they were to blame when, in truth, the cause of the problem was the attitude of the new owner.
Had I bought the original view of the problem, I might have delivered what the owner wanted me to deliver but it’s likely that I would have made the situation worse.
My task was to persuade the owner that what was needed was an intervention with him and, because it is unreasonable to expect one person to turn around the attitudes of fifty or so staff members by himself, with a number his immediate reports and a few other key people in the business.
This was actually a much cheaper intervention than they thought they would be getting. The only problem was that I had to overcome the owner’s belief that it wasn’t his problem, it was the team’s problem. Nothing to do with him—they were the ones underperforming. Of course, this itself was symptom of the whole problem. But that’s another story…