By Prof. Vicente Falconi, FALCONI’s founding partner
Every human organization has as a religious premise that the customer is priority. Ask anyone and they will repeat the mantra: “Our focus is the Customer!” However, most of the time, the reality is quite different and the real problem of any organization is an inability to really satisfy people, the reason and purpose of its existence. This is true for both companies and the State.
It is obvious that the State’s absolute priority should be a citizen-focused policy; that means, among other things, good health, good safety, and good education. It is also obvious that our politicians should be aware of and promote this policy, even if for reasons of self-interest, since it is already a well-known fact that there is significant popular dissatisfaction in this area. It turns out that the State Operational Machine cannot respond to this demand, for reasons already demonstrated in a previous article in this series. The State is not able to answer the Government!
What do “good education”, “good health,” and “good safety” really mean? What is “good” for one person may not be for another. We need simple and transparent indicators (even if imprecise) that numerically measure the performance of these systems in the Municipal, State, and Federal areas. In the case of education we already have IDEB and ENEM, along with the international PISA rankings. The existence of these indicators is a victory and a breakthrough for our country. It does not matter whether these indicators are perfect or imperfect or even that we can improve them in the future – Everything is subject to criticism. The important fact is that they exist and are moving the operational machine of public education, at its three levels, towards continuous improvement. We may not be satisfied with the speed of the improvements in the area of education, but it cannot be denied that they are moving in the right direction. Unfortunately, we do not have the same confidence in the cases of health and safety.
Recently, our consulting organization invested its own funds to outline an ideal health system in Brazil. Several experts, businessmen, and authorities were interviewed in order to map the system and the interactions between the parts of the operational sub-systems of prevention, correction, regulation, and private activities beginning with the pharmaceutical industry all the way to hospitals, laboratories, and insurance companies. It was a stressful job, but we were able to visualize the interactions between all system parts; how the regulations, resources, and services flow; and most importantly, the true boundaries of the health system with the citizen (the customer!). With this map of the health system in hand, we can outline its functions and consequently its main and secondary indicators, which can then be used to understand, analyze, and resolve problems within the system.
To manage is to solve problems, or reach goals, which is the same thing. Where are the real problems of health, education, and safety? The answer is—with the citizen! If we want to solve health problems, we have to analyze the functions of the health system and ask if the process is being effectively carried out. Failure to perform daily tasks correctly and in a standard manner leads to system dysfunctions and other problems, and the first approach to resolve this should always be managerial. One cannot speak of additional resources before there is a clear sequence of efforts to increase familiarity with these functions and their indicators; to raise facts and data; to understand the problems fully; to break down their variations by geography, time, type, and symptoms; and to establish Action Plans from this analysis. However, what we have heard from ministers assume these responsibilities is the declaration on their first day in office that they need tens of billions of Reais to solve general “health problems” that they do not actually understand deeply enough to qualify, much less quantify.
I will cite the case of emergency rooms to illustrate what would constitute recommended management action to improve interaction between the health system and the citizen. Most of these hospitals, if not all of them, are in crisis and cannot meet the demands of the population. We conducted research and found out, for example, that the average time of stay of patients in emergency care was from 10 to 15 days. In comparison, the dozens of private hospitals in Brazil we have worked with boast an average time of stay of 4 days (in many cases less!). This indicates that a simple managerial action in public hospitals could, within a short time, at least double the service capacity of the Brazilian hospital sub-system without any investment. Examples like this exist on several fronts within the health, education, and safety systems. The solution of systemic problems should always start with its interfaces with the citizen and only turn its focus to the system itself if absolutely necessary. For example, I am only going to concentrate on improving a medication procurement process if it has a strong impact on priority problems that affect the citizen’s final service. At the same time, it is obvious that we will have to continually invest in the health, education, and safety systems, but we can only do this in a responsible way, when it is part of an Action Plan resulting from a deep analysis of information to ensure its priority and its benefit for the population. What we cannot do is simply invest more in hospitals that have an average time of stay of 15 days. Before investing, we have to manage!
The real problems lie on the frontier of the State’s main systems with the citizen. The first group to attack these problems should be the people working within these systems. This job is for the State Operational Machine. Solid management knowledge is lacking to make this happen today!
I wish you an excellent government.
VICENTE FALCONI, 74, is founding partner and chairman of Board of FALCONI Consultants for Results. This is one of three letters on sound management addressed to the President of the Republic of Brazil. Read the other two:
Text published in the Folha de São Paulo website – Opinion – 12/02/2014