Our culture and society are awash with regulation and inspection. Virtually every organisation in every walk of life is now subject to intensive levels of scrutiny and compliance backed up by legislatively enforced regulatory regimes. All this, in theory, to ensure that organisations are performing as they should do and delivering good quality services to acceptable standards. The result should be much better organisations kept on their toes by scrupulous inspectors, responsive to public demand and the ever watchful gaze of the media alert to any failings revealed by the inspection process. Everyone involved with organisations, whether as customers, employees or suppliers (or in modern parlance ‘stakeholders’) should benefit.
To be sure a lot of organisations have improved, some quite substantially. There is a myth of a supposed ‘golden age’ when Britain was a country which prided itself on customer care and provided excellent service. The reality is Britain has had a terrible record of providing poor quality shoddy services. In contrast to other countries, working in services is held in no great regard in British society and the standard and quality of public services in the past such as British Rail or the GPO (forerunners of the Post Office and BT) often epitomised indifferent, if not altogether awful services with, in the absence of public redress or publicised inspections, minimal risk of exposure. Now such organisations, in theory, have to be prepared to be called to account for any short-comings, particularly in the delivery of services (often prefixed with the term “frontline”) and there has no doubt been some improvement in their response to criticism bolstered by inspection compared to their previous position of utter disregard of public opinion.
There are a lot of qualifications in that last paragraph. And the reason is that inspection, regulation, indeed the entire edifice of the ‘culture of audit’ does not necessarily lead to improved services or better organisations. I once stayed in a hotel which proudly displayed a string of awards and certificates from a host of agencies ranging from specialists in hotel standards, people promoting good practice in how organisations treat their employees to health and safe, good food and hygiene and a raft of other commendations, all proudly and prominently displayed on walls in the reception area, the dining room and other public spaces. The reality was that the hotel was a dingy, cramped, overcrowded place serving disgusting food with indifferent service at overcrowded prices manned by rushed, weary and indifferent staff managed by a Basil Fawlty stand-in. The discrepancy between the much vaunted displays, certificates and awards attesting to the excellence of the hotel and the reality of the run-down, fleapit it was, was all too stark and palpable.
Now a hotel, for most people is concerned with leisure and recreation. Your health is a different matter, concerned with matters that can literally relate to life and death. Yet, even here there are massive discrepancies between positive, even glowing inspection reports and the reality. In October the Care Quality Commission (CQC) in England and Wales rated hospitals in Essex as “good”, but were subsequently discovered to be anything but. The same organisation gave hospitals in the mid-Staffordshire NHS Trust star quality ratings indicating excellence when in fact standards were appalling and “where between 400 and 1,200 people died through failings in urgent care”. How could this happen? Why such massive discrepancies between an inspection and what’s actually happening?
Partly, the answer lies in what is being measured or assessed. A lot of inspections are really about process. That is to say they look at what systems are in place and most importantly what polices, procedures and protocols there are within the organisation and how they are being adhered to. This can result in farcical situations. A small-to-medium sized organisation (or to use more jargon an “SME” – the “E” is for enterprise) can be working away quite efficiently delivering good quality services, with a happy, relatively contented workforce (for workforces, no matter how good the company, will never be always happy) and quite satisfied customers, but here comes the inspectors.
Q: Where’s your employee consultation policy? A: Don’t have one. Bad mark, grim frown on face of inspector, no box ticked.
Q: What about anti-discrimination and equalities policies? A: (Scratch of head) eh haven’t got any, haven’t really had time to eh do them. More shaking of head and muttering of “not good enough”.
Q: What quality assurance systems and processes are in place to involve service users, carers, staff and stakeholders to assess the quality of service you provide? A: More blank looks, awkward silence followed by a plaintive “sorry, come again”?
And so on. No boxes ticked, null points, a disastrous inspection with all the possible consequences that flow from that, including loss of funding.
Meanwhile another organisation with a discontented workforce, at best indifferent, at worst unsatisfactory services and customer satisfaction levels can walk away with gold star inspections because all the boxes around, policies, protocols, consultation forums etc are filled in. And this surreal situation of genuinely decent organisations getting bad inspection reports and dreadful ones getting commendable ones can go on until adverse publicity or some other calamity blows the whole farrago apart and, unfortunately brings the entire notion of inspection into disrepute as has happened with the inspections into the various health authorities in England.
An oft quoted old Scottish expression comes to mind here: All fur coat and nae knickers. Meaning: a concentration, indeed almost obsession with surface appearances at the expense of more basic, less glamorous but vital components that really are essential to wellbeing. In the case referred to above, elements of social policy, undoubtedly laudable in themselves, are being used as the yardsticks by which organisations are being measured. The actual product or services organisations produce or deliver, as well as the actual outcomes and difference they make, take second place to how adherence to a series of desired policy objectives are being met. No doubt the Health Trusts when being inspected were able to show first-class polices on equalities, employee consultation, risk assessments, minutes of meetings, training records, adherence to national quality standards on this and that etc. All boxes ticked. But the reality was filthy wards, appalling treatment and care, poor staffing allied to harassed staff trying to do critical and important jobs and, yes, dying patients.
Inspection is good when it is about really trying to measure what actually goes on in organisations and what outcomes and value added is being delivered to the communities they serve. It goes badly (and in this case catastrophically) awry when it tries to force-fit real, living entities such as schools, colleges, factories, offices, charities etc, and the human beings that work in them, into compliance with grand social policy frameworks. In a real sense then, organisations, via the cult of inspection, are being used as yardsticks for societal adherence to desired social norms, rather than for what they actually do and how good or bad they are at doing it
This situation is compounded by two other factors which are now endemic in the inspection process as currently practiced. One is lack of scope wherein small organisations are subject to the same levels of compliance, inspection and regulation as much larger organisations and duplication where organisations can be inspected umpteen times by different regulatory bodies.
The consequences are bureaucratic inertia, stifling of initiative, chronic risk aversion resulting in a process driven, tick box culture where form is demonstrably superior and safer to content. And this spectre, this culture of inspection, of the audit, of compliance and regulation and the dread consequences of non-or-inadequate conformity –whether it be legal, financial, or even just reputational now haunts the land and insinuates itself into every aspect of organisational and even sub-organisational life.
The ramifications of this dread hand are only now beginning to be faced up to and there is the start of a healthy and constructive debate about the proper role of inspection, and more importantly the limitations of it. Meikle’s Blog shall return to this issue in the New Year.
Meanwhile to anyway out there who may be reading this or any of the blogs I’ve been scribbling over the past few months (comments and feedback always welcome) merry Christmas and a happy New Year to you and your loved ones.
Meikle’s Blog will be back in the second week of January.