The inestimable Atul Gawande (author of The Checklist Manifesto) has done it again with a brilliant little column in the New Yorker.
Gawande sets out a startlingly argument – what separates mediocre performing hospitals or surgical teams is not, as most of would suppose, how good they are at routinely doing “best practice”. No, what makes for excellence is how you respond when things go wrong (as they always do). The truly excellent excel at recognising something has gone wrong and responding with an appropriate plan of action to put things right.
Of course, this does not mean that “standard operating procedures” that try to ensure “right first time” or “just in time” are wrong. It is just that they are limited. They are limited in their effectiveness by how predictable and uncomplicated the ‘production’ process is. The more complex and unpredictable a system, the more often things will go wrong in even the best designed systems.
The consequences for public policy – which is more often than not dealing with complex, human, and fallible systems, is immense. Establishing ‘best practice’, which is actually ‘best practice in normal circumstances’ is fine. But it only gets you so far.The real challenge is to deal with what happens when ‘best practice’ fails.
As Guwande points out, when you are practicing ‘best practice’ it is very hard to recognise when things are going wrong. How can they be, you are doing everything ‘right’. But in the real world of human interactions, gene the best of ‘best practice’ leaves a small percentage of cases where where it goes wrong. It is how quickly and clearly we recognise this, and come up with a sound plan to deal with it, that really determines excellence.
Take outsourcing as an example – it is fine to say that outsourced services can work well for most cases. But what about when it isn’t fine? G4S and the Olympics is a a case in point – they might have been forgiven if they’d had a recovery plan. Instead they just gave up and handed over most of what they were supposed to be doing to the military. It is not routine efficiency that matters, but dealing with the unexpected.
In a whole host of areas – prisons, probation, benefits, child protection, education, health care, etc – we should be asking not ‘how good is their standard operating procedure’ but ‘how good is their rescue and recovery plan’ for when things go wrong. Because, rest assured, they will go wrong. And it’s what you do when it happens that counts.
