While working as an NHS consultant anaesthetist, I wrote about myopic short-term approaches to complex problems. Contracting out cleaning and catering to the cheapest providers led to surges in hospital-acquired infections and patient malnutrition, and so to increases in morbidity, mortality – and costs. Public finance initiatives to build new hospitals resulted in long-term debts and fewer beds. Targets caused distortion of clinical priorities: treating a hundred extra varicose veins within five weeks was more politically expedient than 10 urgent joint replacements.
Carl Honoré's book, advocating slow, considered and well-informed approaches to such complex problems, echoes this scepticism about quick fixes. His previous two books explored the benefits of what he calls The Slow Movement, and its relevance to parenting. In The Slow Fix, he examines examples of initiatives where this method has worked.
Companies downsizing to balance the books come to grief as quality standards and employee satisfaction plummet. Initiatives to link teachers' pay to pupil performance in New York cost $55m and failed to improve standards. Aid programmes where victims are not involved in decision-making are often costly failures.
Honoré's positive examples are impressive. The RAF and Exxon Mobil both have a culture of encouraging criticism from staff; even rewarding it – rare in today's culture of gagged and punished whistleblowers. A prison in Norway concentrates more on rehabilitation than punishment, and recidivism is 20 per cent compared to 50 per cent-plus in the UK. A school in a deprived area of LA has transformed from a failing hell-hole to success, with pupils feeling nurtured and encouraged. Coffee farmers, charities and more have benefited from the slow fix.
Honoré defines the key criteria, including the admission of failure, a holistic approach, collaboration, local devolution of power, crowd involvement and strong, receptive leadership. Accessible, lucid and wise, this book should sit in every government and managerial office.
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