04 June 2021
NIGHTINGALES & THE FIVE WHYS
Today’s mail brought response from a UN connected person, with a simple message of appreciation. I felt that my message had reached the common global citizen. It brought also the Twitter sharing by Dr Thurairajah – of the article Kingsfund ‘Was building the NHS Nightingale hospitals worth the money?’ – by Siva Anandaciva – who is presented as UK’s chief analyst in the policy team, leading on projects covering NHS funding, finances, productivity and performance. Both names indicate that they are Tamils / of Tamil origin.
Siva introduces the subject-matter as follows:
[Florence Nightingale received seven unexpected tributes in the 200th-anniversary year of her birth. In late March 2020, as concerns grew that Covid-19 would overwhelm the NHS’s critical care capacity, emergency NHS ‘Nightingale’ hospitals sprung up from Exeter to Sunderland with the aim of supporting the NHS to cope with surging number of people with Covid-19…
England was not alone in pursuing this approach, with countries from Argentina to China also rapidly creating facilities to treat large numbers of patients. And although the quest for more NHS capacity in England involved block-booking capacity in private sector hospitals; adapting existing NHS hospitals to care for more critically ill patients; and developing primary care ‘hot hubs’, long-Covid clinics and (for a brief moment) NHS Seacole centres, it was the Nightingales that often captured national attention and featured prominently in early media reports of the NHS’s response to the pandemic.
The seven Nightingales had different purposes – with some mainly set up as critical care facilities and others designed to deliver step-down care for recovering patients ….. But the hospitals shared at least one common goal (listed on one of the hospitals own websites): ‘Bring hope’. ]
The purpose of the article is indicated as follows:
[Inevitably then, there have been disagreements over whether
the Nightingales – which were created at the cost of more than £530 million – should be seen as white
elephants that could never have been used, or as the ‘ultimate insurance policy that were thankfully not
The ‘five whys’ can be a simple but powerful way of getting to the root of an issue. But two whys may suffice in this case: were the Nightingales a waste of money? Why? Because they didn’t see many patients. Why? Because there weren’t enough staff to run them?]
Five Whys is presented by Wikipedia as follows:
‘Five whys (or 5 whys) is an iterative interrogative technique used to explore the cause-and-effect relationships underlying a particular problem. The primary goal of the technique is to determine the root cause of a defect or problem by repeating the question "Why?". Each answer forms the basis of the next question. The "five" in the name derives from an anecdotal observation on the number of iterations needed to resolve the problem.’
During my challenges at the University of NSW, I often wrote about the importance of knowing ‘why’ more than ‘what’. Some are indicated in Appendix 1 of my book Naan Australian from which the relevant excerpt is appended below.
I came across the ‘Five ways’ method referred to by Siva, for the first time today. But I was already using the core value of that theory in my work here in Australia in relation to Public Resource Management. How? By being true to myself and attributing credit to my Sri Lankan education which was thus made Universal. I felt that by then, I had become independent of any particular person and this happened by me absorbing discrimination pain without lowering my standards. This I believe, leads to ‘ownership’ in the whole. Owners have intuition and hence Performance Indicators are developed by such owners – to detect problems early and prevent negative manifestations . Through the communication (below) with the Auditor General who claimed that Performance Indicators could be used in Audits – I was claiming that such use was in breach of the Separation of Powers between the Auditor and the Management.
Siva seems to have made the same mistake as our then Auditor General (AG):
[An investigation by the National Audit Office (NAO) would be the clearest way to cut through these competing narratives and determine if (a) the Nightingales weren’t needed – because other measures both to contain the spread of Covis-19 and to maximise the use of existing NHS facilities were effective; or (b) the Nightingales were needed but couldn’t be used because of a lack of available staff.]
My response is indicated by the following section of my response to the AG:
[You need to get the client organization to publish their non-financial reports that are mandatorily maintained. Public service organizations primarily make goodwill. This can also be positive or negative – profits or losses. They are collected together and are balanced with the total costs through Common Funds. It will be useful for you to develop a standard dollar value for these legal requirements so the People can SEE and know the Truth. Your role is not to help them make a profit but to report whether they are and how much. How about doing one on UNSW? Or State Rail?]
The value of Goodwill is exponential due to its invisibility. It is the Opposition of Covid19 which also spread exponentially due to Silkroad heritage being damaged. In this instance, as per my belief Covid19 prevented wars, by pushing nations to remain within their sovereign borders. To the extent we invested more in medical sciences relative to warfare we were successful in preventing and / or getting cured of the effects of the King-Virus. UK has the parallel of Silkroad heritage through Angel Nurse Nightingale presented as follows by Wikipedia:
[Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers at Constantinople. She gave nursing a favourable reputation and became an icon of Victorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night.]
I believe that this was the true cause of the British PM’s recovery from the attack by the King-virus, which he also attributed to as soon as he could – as per his conscience. This is also preventive power that would protect the UK from engaging in unjust wars.
The ‘Nightingale’ hospitals are sacred and they cannot be measured by visible or knowable benefits alone. They are like war memorials. We have many of them in Northern Sri Lanka, including in Thunaivi, Vaddukoddai. They are idle most of the time but they confirm reparations that would reduce the possibility of future wars causing pain to those to whom those areas are ‘heritage homes’.
Re Public challenge of misleading statements of principles by the New South Wales (Australia) Auditor General Mr. Bob Sendt:
Sendt wrote on
Ms Param, I fully understand that auditors are not to participate in the management of the entities they audit. That is basic. What I said in my report is that external financial reports only give a partial view of the performance of many public entities. Such entities are not established to earn a profit or a return on assets, but to provide services to the public. So to give a true and fair view of how well they are providing services, they also produce non-financial performance indicators. If financial reports are required to be audited – to give the public confidence in their accuracy – then so too should the performance indicators. I fail to see how you can state that this is participating in the management of the entity.
NSW Auditor General
My response to the above indicates the deep wisdom I have in Audit and Compliance, largely based on my Sri Lankan training:
Thank you Mr. Sendt for the prompt response. Most progressive organizations produce both – Financial and Non-Financial Performance Indicators. They are both for MANAGEMENT purposes and reflect the THINKING and WORK_IN_PROGRESS. If you use Performance Indicators – then you are thinking with them. This is like the Executive Government participating in the Judicial process. Your Non-Financial Reports are the Legal records that these organizations are required to maintain – such as the Recruitment and Employee Assessment records. Where there is a big gap between Law and Practice – it requires YOUR staff to do the additional work. Taking the Performance Indicators distracts you away from this work. It is in breach of the Doctrine of Separation of Powers. These organizations must be allowed to confidentially do the cooking and it’s up to your staff to do the spy work from the finished product to the LAW and not to their dreams and goals. You are seeking the short path because your staff are not trained to find out from the client staff what is going on. Staff often ‘hide’ information from you because you are third party. So they should. That way your staff would improve their skills. Using client-staff’s work-in-progress deters your staff from thinking through their own specialty = AUDIT on the basis of existing LAW. Then we would become a uniform society instead of a diverse society challenging each other – you within the existing law and the operational staff towards tomorrow’s laws. Challenging leads to creativity – as you can see from me. Gandhi also said that the night he was thrown out of the first class compartment of the South African RAILWAYS was his most creative experience.
You need to get the client organization to publish their non-financial reports that are mandatorily maintained. Public service organizations primarily make goodwill. This can also be positive or negative – profits or losses. They are collected together and are balanced with the total costs through Common Funds. It will be useful for you to develop a standard dollar value for these legal requirements so the People can SEE and know the Truth. Your role is not to help them make a profit but to report whether they are and how much. How about doing one on UNSW? Or State Rail?
Thank you again for responding. It has helped deeply.
Gaja ( effectively in custody)