All of the talk about FDP and its successes/failures over the week reminds me of a story
I read recently in Matthew Syed's excellent book, Black Box Thinking.
Unilever made washing powder at a factory near Liverpool the way it's still made today: boiling chemicals forced through a nozzle at high pressure, dispersing into vapour and powder as the pressure drops. The trouble was that the nozzles kept clogging, and when they did work, they produced grains of inconsistent size.
Unilever first handed the problem to its mathematicians and physicists - the best experts in high-pressure systems and fluid dynamics money could buy. They worked through the phase-transition physics, derived complex equations, and eventually produced a new design - which was still inefficient. The theory, in other words, couldn't crack it.
So, almost in desperation, they turned to their biologists, who knew nothing about fluid dynamics or the physics of high-pressure systems but understood evolution. They made ten copies of the nozzle, each slightly varied - some longer, some shorter, different hole sizes, some with grooves - and tested them all. One improved on the original by maybe one or two percent; they took that winner, made ten fresh variations of it, and repeated the process again and again. After 45 generations and 449 'failures', they had an outstanding nozzle.
The sting in the tail, and the bit Sye
d leans on hardest: Unilever had a brilliant nozzle and the method that produced it, but they never knew why it worked - the design emerged from variation and selection, not from understanding. As Syed puts it, progress came not through a beautifully constructed masterplan, but through rapid iteration. The anecdote originally comes from the geneticist Steve Jones, whom Syed cites.
In the NHS, when we talk about technology X delivering solution Y, we miss the point. It wasn't the tool that delivered the improvement; it was the transformation - the tool is only a small part. Bringi
ng focus, changing perceptions and challenging the status quo delivers clinical excellence - not a tool.
Anyone in NHS quality improvement will recognise the Unilever method instantly: it's the PDSA cycle - Plan, Do, Study, Act - just with detergent nozzles instead of discharge pathways. Service improvement should always be iterative, and iterative change never sits comfortably inside a traditional, linear PRINCE2 methodology.
Unilever's engineers never did understand why their nozzle worked. They didn't need to. They just needed the willingness to fail 449 times and learn from every one. If we're serious about improving the NHS, let's stop asking which technology will fix it - and start building the culture that's willing to iterate its way to the answer.
That's the transformation. The tool is just the nozzle.
Syed, M. (2015) Black Box Thinking: Marginal Gains and the Secrets of High Performance. London: John Murray.
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