Thursday, 24 September 2015

Triangulation points…


In the mid 1980s Dr Martin Barnes created the Triangle of Objectives. The triangle demonstrates that quality, cost and time are interrelated. Focussing or fixing one point of the triangle impacts the other two.

I first came across the above ‘project management triangle’ or ‘triple constraint’ – sometimes also known as the ‘scope’ or ‘cost-quality tradeoff triangle’; and “one of the most well known and well respected mechanisms for signifying the interaction of the key attributes of a project” – when working for a software development company, over a quarter of a century ago: it being stressed, at the time, that “You can optimise for two at the expense of the third, but you can’t maximise all three at once”; or, as one colleague put it to me, a few years later (and a little more bluntly): “Time, cost or quality – which two do you want?”

I only raise this device, because, in a recent post – prompted by a problem with (actually a failure of) my hearing aids that was, at the time, (shall we say) dealt with less than satisfactorily by the NHS – I made a plea to those in power, those that (should) care for us: writing that…

We did not choose to be born or become deaf…. Do not treat us, therefore, as if we are the deserved lowest of the low. Instead, please offer us the hand we need… – your hand.

…and yet – call me an old cynic (which I am: on both counts) – to my amazement, my supplication was answered. Not at first, natch – although I did receive one of the better attempts at a response to my list of criticisms: even if, as with all such ‘standard flea letters’, it either deliberately or unintentionally ignored some of those most salient… – but then, the writer was the person at who I had singularly aimed my vehement reproof; and therefore very much on the back foot. But I was then – once spleen had been vented (albeit inaccurately and incompletely); and satisfaction was (sort of) seen to have been had… – referred to the care (and that is certainly the correct term) of someone who obviously gave a damn. And then some.


It would – as a qualified grump – be all too simple to infer that this apparently newly-enlightened customer service (not ‘patient care’: we are all “customers” now – even in an healthcare delivery environment) was an act; a performance simply to quell (or satisfy) my grumblings: motivated solely by my complaint (not that one should need to complain, to receive good service – especially as there is an associated risk of revenge…). But it was actually astoundingly obvious – and from the moment I entered this lady’s “care” (I won’t embarrass her by publishing her name…) – that here was someone who actually, continually, sincerely, and consistently, innately, was interested in my perspective, needs and wants; was bothered; gave so much more than a monkey’s. And had obviously made a career of combining her expertise with a deep desire to help. Someone who was not only interested in those “needs and wants”; but was willing to take the time (and the time-consuming steps) to deliver what I, as a consultant, would once have called a ‘quality outcome’ – no conditions attached.

By the way: you could, of course, moot that no element of cost was involved in such a transaction – but the scheduled forty-five minute appointment started a quarter-of-an-hour early; and then ran over by not quite an hour: and there is, of course, a financial outlay associated with the provision of both the ministration of compassionate co-operation (by way of salary, office use, etc.); as well as that of the replacement equipment required to solve the problems I had suffered and therefore raised.


Never before had my hearing been so thoroughly deconstructed – and then rebuilt, tiny piece by tiny piece! And, therefore, never – or, at least, not since I was first issued with hearing ‘instruments’, over six years ago – has my digitally-reinforced soundscape been so clear, so strong… indeed, so bloody wonderful! Such amazing customer service, needless to say, should be the norm, though, not the exception. But, of course, the NHS has been stressed by successive governments into shrinking all components of that ‘tradeoff triangle’ – with not-so-surprising results (well, not to those with hearts and brains). Not that this “stress” should be an excuse for contracting compassion; attenuating attention. In some ways, these ‘qualities’ should be increased – to compensate for the shortening of appointment times; and the diminishing economic investment. They are the reason those who can afford such care, use private medicine; and those who can’t, migrate to ‘alternative’ healthcare: where attention and treatment is holistic and personalized; and time is taken to understand the individual.

I could, of course, go into a prolonged rant, now, about the creeping privatization of the NHS; the decimation (and beyond) of all public sector support of “the individual” – whether childcare; education; transport; or social care, etc.. But this is not (yet?) the time or the place. This is just to say a big thank you to the lovely, attentive, understanding, remarkable, adept audiologist who went several giant steps beyond the norm. And to whom I therefore owe a great deal – for the improvement she has made, not just to my hearing; but, consequently, all aspects of social interaction and enjoyment of the world around me.

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