I have been promising for a while now to write up this case study and here goes.
Attendance management is a major issue for businesses, public sector bodies and voluntary and community sector organisations. However, of the three sectors, the public sector is the one most often put under the media microscope as to the level of its sick absences. There is usually a comparison with the private sector that is never other than detrimental to the public sector.
Firstly, I challenge the validity of such comparisons on the grounds that such a crude approach is of little or no value to addressing the issue of attendance management, but it does generate excellent ratings and viewing figures. Secondly, I would contend that the figures for sick absence in the public sector are more likely than not to be more accurate than those for the private sector. However, even if the absence levels were similar then that would not be a sufficient argument to not look at how matters might be improved. Incidentally, when next a media outlet runs an attendance management story check to see if their own organisation’s sick absence record is included in the debate. I would be very surprised to learn if it is.
The Anglo Saxon Business School of Management approach to tackling sickness absence invariably involves a mix of carrots and sticks. The balance between carrot and stick varying as much with the ethos of the organisation as it does with the effectiveness of the carrots and sticks being dangled and applied. The best that may be said for many of these approaches is that they are unlikely to increase the level of sick absences.
The stick approach tends to turn sick absence management into a disciplinary matter thereby brigading it with those who take unauthorised leave. Quite often such an approach increases stress levels for the absentee and their manager. Consequently, the level of time off work may increase not fall. Alternatively, those who feel intimidated by the process and so return to work earlier than they should may not only spread infections to co workers, but also need more time off a few days later to fully recover from their own illness. Stick policies have a tendency to drive up absence and are toughened to address the increased absence and so on.
The carrot approach is harmless although sometimes demeaning. Gold stars for good attendance. An end of financial year letter congratulating one for not having a day off sick for the whole year from the District Manager and similar. A slightly different approach is to be more proactive, for example by arranging lifestyle checks, providing free gym memberships, courses in time and stress management. Alas, I never seemed to have the time to put the stress avoidance techniques into practice! Seriously, if you are suffering from sick organisation syndrome then no amount of yoga or massage sessions are going to make you any less prone to illness.
Sick organisation syndrome brings me neatly to the Royal Mail and the approach they adopted to addressing attendance management about 25 years ago. RM had recently begun to practice Total Quality Management and felt attendance management was an area on which they might usefully deploy the TQM tools and techniques. The first aspect of the approach is to determine whether or not you have a problem. If you do, is the problem partially or totally within your control? A problem caused, for example solely by the weather is unlikely to be controllable and so may only at best be mitigated rather than resolved. If the problem is within your grasp to address is it a significant one? Is it worth spending time and effort on addressing it rather than some other aspect of your business or organisation’s operations?
For RM, they felt they had a problem with levels of attendance management, that it was at least partially something they might influence and that it was a significant issue deserving attention as a matter of priority. Sick absence affected service levels, customer satisfaction and increased the salary bill through recruitment of casual staff to cover absences. In addition, absences caused more work for those not off sick and so increased the likelihood of them becoming unwell if their workloads were above the normal level for any significant period of time. Staff morale is (or should be) very much of a concern, particularly to those whose business is serving members of the public whether they be patients, passengers or customers. Take note, TQM works as well in the NHS or a Jobcentre as on the shop floor at Jaguar. I know, I have seen the improvements made through TQM in Jobcentres, I have been told by TQM clinicians about how it is used to improve care on acute wards and I have seen it in action at Jaguar’s Castle Bromwich plant.
RM decided to use one fairly typical postal district as a starting point for further analysis. They then gathered together all the sick notes for a given time period and divided them up by type of illness or condition. They then used a Pareto approach where the piles of notes were set alongside each other with the highest pile on the left descending to the lowest pile on the right. They then worked through the piles removing those outside of their control such as legs broken on holiday, appendectomies etc. They were then left with two sizeable piles and some much smaller ones.
The first pile was a collection of foot related conditions. Some of these cases were diagnosed as trench foot. The largest number of absences was down to delivery workers being unable to get around on foot. Some years before, RM had provided each member of staff with two good quality pairs of shoes each year with an expectation that they wear them, unless medically advised not to do so. One day RM hired some management consultants to identify areas where they might ‘save’ money. They had recommended withdrawing the business provided shoes. RM acted on their recommendation and staff wore whatever they felt was suitable and/or could afford. Most of the foot related absences were traced back to this saving. A case of a known unknown. We know we will save money, but not what the real cost, if any of doing so will be. The consultants had of course collected their fee and were long gone. Incidentally, TQM is to many management consultants like garlic is to a vampire.
The second pile was injuries incurred by van drivers, in particular those collecting mail from post boxes. Many of the injuries were shoulder related. Further investigation revealed drivers were quite often not wearing their seat belts and/or sliding closed the driver side door. Consequently, when they braked for any reason they ran the risk of injury.
These two categories of condition made up the bulk of the causes of the absences so remedying them would significantly improve attendance management. Back came the shoes on the same conditions as before. The collection drivers were told to wear their seat belts and close the doors, but crucially the timings of their rounds were increased, the number of points from which they collected reduced and more drivers and vans provided. You will note, I trust, that both solutions require actions by management and staff to be effective. By the way, trades unions like TQM, because an evidence based approach rarely weakens their arguments. Moreover, discussing data about which both management and trades unions agree helps to makes negotiation generate more light than heat (or so I have been told).
One other aspect of the TQM approach is that it is scalable so absences felt not worth investigating at a District level might well be worth looking into at an individual office level. For example, Ms X (no names, no pack drill) worked in a Jobcentre and routinely asked for leave at the last minute and quite often had her requests turned down. She then frequently went sick for the same period for which she had asked to take as leave. Ms X is certainly the sort of case that would trigger at least an informal warning. That it did not do so did nothing for the morale of her co workers. In addition, Ms X’s husband invariably used to ring in to the office saying she was not well and usually told us precisely what day she would be returning to work. It never seems to have occurred to either of them that sick leave was not an addition to Ms X’s annual leave entitlement. Ms X used her sick absences to cover half term holidays and so on.
You did not need to adopt a TQM approach to match Ms X’s absences with school holidays. However, a TQM approach does create a basis on which responses to absences by different individuals may be made on the basis of their personal circumstances and not in line with a one size fits all policy. A policy approach that invariably increases absence rather than reducing it. A flexible policy, sensitively, but firmly applied to all those absentees is good for them, their co workers and those for whom they work.
RM’s variation on Ms X was Mr Y who quite often asked for Thursdays off at short notice. And mostly he was not allowed the time off. It became apparent through analysing his (self certified) sick notes that he had a tendency to develop 24 hour bugs for those Thursdays he had wanted to take off, but which he was told he had to work. And the Wednesday evenings before these Thursdays were co-incidentally those days when the football club he supported were playing an away fixture.
I must stress that the above is not an example of good practice to be slavishly copied by people wanting to reduce the number of sick absences within their organisation. It is a case study. A big concern of those who advocate TQM is that people tend to ignore the process by which improvements are made and simply pick the solutions they hope may work for them. The reason why many management consultants fear TQM is that once you have learnt how to apply the tools and techniques then your need for their services reduces significantly. You design your own systems and processes to deliver the goods and services that meet the requirements of your service users, customers, patients and passengers. Moreover, as those requirements change you evolve your systems and processes to address those changes. TQM accepts, if not embraces the need for continuous process improvement. The organisation that does not evolve to meet changing customer need dies or at least loses goodwill.
No political party shows much sign of grasping the fact that unless we challenge perceived wisdom, the Anglo Saxon Business Model, then they may make whatever pledges they like, because British management (in whatever sector of the economy) is mostly incapable of making those pledges a reality in a way that will make the electorate feel they have been met. In particular, both ukip and the Green Party have a touching faith that business as usual (in Whitehall and local government) would deliver their policies effectively and efficiently were they ever to form part of a Government. Andy Burnham has at least shown signs that he recognises that a TQM approach may be the only way to both shore up the NHS and allow it to develop its services to meet the need of individual patients.
TQM poses a challenge to extremists on both the right and the left. It says to both groups that a confrontational approach in labour relations is destructive and that an evidence based approach creates common ground between both parties. It also says that organisations and businesses exist solely to serve their users and customers, because only if they do so will they create value and profits. It says to many on the right that cuts invariably result in increased costs and to a few on the left that savings may be achieved whilst maintaining and improving service delivery. Moreover, that savings create headroom within budgets and therefore the answer, in part, to shortages of funding is to make those savings to create that headroom. Not everything in the public sector may be improved by throwing money at it.
In fact, given the state in which management in both Whitehall and local government are now in, it is unlikely they could make effective use of additional funding until their ability to manage it has been significantly improved. Those on the left who think the public sector may be turned around on a dime sometimes seem more out of touch with reality than some of ukip’s supporters. As for the Green Party’s middle class, middle management (quite often salaried public sector) supporters then they strike me as being part of Britain’s management problems rather than the solution to them. IDS and Universal Credit in practice are what Natalie Bennett and the Basic Income are in theory. The only difference being that the Green Party is well intentioned. Note to the Green Party, railways in whatever sector they are should be run in the interests of passengers not the passengers, their workers and the people. You will see from the above than when RM effectively addressed attendance management they improved customer service and the well being of their staff.
We appear have tried everything else, except an evidence based approach to management. Time we consigned the Anglo Saxon Business School of Management approach to an industrial heritage museum. Time we kissed goodbye to the thinking that said Japan was dumping cars at below cost price in the USA, because US car firms could not produce them at the same price and make a profit. The likes of Toyota could and still do. Toyota’s big recall a few years back was because they had turned their backs on over half a century of practising TQM. A senior executive went public, said they had made a mistake and that they were going back to TQM. Such a statement was a major loss of face. When US car firms were being ‘dumped’ on their Chief Executive Officers and Presidents had the bare faced cheek to go to Japan (with Bush Senior) to put their case. Bare faced? They earnt many times more than their opposite numbers in Japan and yet their companies were not as profitable as those of the competition. Moreover, their counterparts in Japan only received salaries about 11 or so times as much as their shop floor workers. In the USA no one would consider themselves valued as a CEO or President, if they were not at least offered more than 11 times as much in salary as their front line staff.
One final point, TQM, because it incorporates a philosophy of Plan, Do, Observe and Act is the closest many of us will ever come to continuous (r)evolution. Yes, dear reader, TQM is Marxism in a management setting.
William Edwards Deming
Total Quality Management
Total Quality Management (and Ethical Values)
The UK Retail Industry: A Case of (Paying Lip Service to) TQM at Tesco Supermarket?
Five Deming Principles That Help Healthcare Process Improvement
Deming’s Quality Principles: A Health Care Application
Do Doctors Need Deming?
Selected Articles By Dr Deming
The Deming Institute