Measurement and Labelling: a defence against organisational ambiguity'

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Measurement and Labelling a defence against
organisational ambiguity.
Rev Mike D Williams
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Thank you for the work that you do for patients
and staff in the NHS
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• Uncertainty and ambiguity spotting the
  difference
• Where the buck stops the Chief Executive
• The rise of the non-executive and Board
  responsibility
• Measuring and labelling understanding the world
• Sense making more than numbers
• Survive or thrive - spiritual and pastoral care
• Discussion

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Ambiguity and uncertainty
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Gaeta, Italy
Increasing information can decrease uncertainty
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You are experts in ambiguity
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You are experts in ambiguity

• The universe is religiously ambiguous in that
  it is possible to interpret it, intellectually
  and experientially, both religiously and
  naturalistically. The theistic and anti-theistic
  arguments are all inconclusive, for all the
  special evidences to which they appeal are also
  capable of being understood in terms of the
  contrary world view. Further, the opposing set of
  evidences cannot be given objectively
  quantifiable values.
• John Hick quoted in McKim R. (2001) Religious
  Ambiguity and Religious Diversity, OUP Oxford,
  p21.

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Decisions must be made
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A hazardous occupation
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RAB Resource Accounting Budgeting system used
across government
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No mention of MONEY !
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Managers
Politicians DoH
Command Targets performance mgt
Consumer Rhetoric Choice
Clinicians
Public Patients
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Managers
Politicians DoH
Command Targets performance mgt
Mistrust as underlying ethic not clear
Consumer Rhetoric Choice
Mistrust
Clinicians
Public Patients
Trust based on bioethical principles
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The ethical options for NHS Managers

• Place the patient at the centre of all decisions
  medical ethical approach
• Place the business requirements of the hospital
  at the centre of all decisions business ethics
  of balancing money, targets and safety
• Avoid all ethical considerations
• Find a combination of medical and business ethics

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Oxfordshire Learning Disability NHS Trust Board
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The Law of Unintended Consequences
is alive and well
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Paradigm of success
Paradigm of success
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Who had the bar code reader ?
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Ever felt like this?
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After one of these?
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• The task of prophetic ministry is to nurture,
  nourish and evoke a consciousness and perception
  alternative to the consciousness and of the
  dominant culture around us.
• Walter Brueggemann (1978)
• The Prophetic Imagination. Fortress Press, p.13

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Sensemaking in Organisations

• Sensemaking is a process that is
• Grounded in identity construction
• Retrospective
• Enactive of sensible environments
• Social
• Ongoing
• Focused on and by extracting cues
• Driven by plausibility rather than accuracy

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Management by command OR Management by
principles Director General for HR, Dept of
Health, June 08

• Values of the NHS
• Respect and dignity
• Commitment to quality of care
• Compassion
• Improving lives
• Working together
• Everyone counts

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Survive or Thrive

• Religions that flourish over a long period,
  that are central to the lives of their adherents,
  and that influence many people must be adapted
  to the circumstances of their adherents.
• a religion that failed to provide an
  interpretation of, and hence a way to cope with,
  important events in peoples lives such as birth,
  death, bereavement, coming of age, and so forth,
  would not survive
• McKim R. (2001) Religious Ambiguity and Religious
  Diversity, OUP Oxford, p22

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• ...religions do not need to be authoritarian to
  possess authority Their influence lies only in
  the force of their example, the cogency of their
  teachings and the spiritual beauty of the lives
  they inspire.
• Jonathan Sacks (2005)
• The Persistence of Faith, Continuum, London p.107

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Be confident, bold and prophetic

• Your role embodies the value base of the NHS

Now when they saw the boldness of Peter and John
and realised that they were uneducated and
ordinary men, they were amazed and recognised
them as companions of Jesus. Acts 4.13
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Thank you