Managers and clinicians in public health are so busy they simply do not have time to think of better ways of working, of learning new ways of working that would make their work easier, more effective and more efficient. They are stuck in a busyness vortex that is keeping them stuck in time – and yet the demands on their time are increasing and changing. They are so fixated on getting things done on time, that they can’t stop to reflect if these things are the right things, or if it is possible for someone else, or something else, to do these things.
And it is the same for management. I have noticed how managers in the public health care system can be really task focused. Understandable. Their performance metrics are all about tasks and time – not people, process or improvement. They struggle to find the time to improve their own management practices. So it should be no surprise that they continue to apply management principles and practices that are outdated and tend to demotivate rather than inspire engagement. And this is the irony of healthcare – the clinical workforce is highly qualified and skilled. They can perform their core functions autonomously – and do not need a manager to tell them what to do. In fact, we see evidence of this fact when, despite really poor management, the show goes on – patients are still seen and treated. Even when clinicians are disengaged from the organisation, stressed out or even burned out, they continue to see and treat their patients. The cracks show in the lack of care with which this is delivered. Patient experience is possibly the best indicator of clinician engagement.
Dan Pink explains how skilled employees are motivated less by money and more by purpose, mastery and autonomy. But this is not a new idea. Warren Bennis, nearly 50 years earlier, predicted that organisations would morph into “organic-adaptive structures’ – more like communities and less like hierarchies. Where people were motivated intrinsically by a purpose, not extrinsically by a pay packet. Control was diffuse and drew from shared aspirations and culture – not centralised in the boss and policies. Roles and contributions were not predetermined – people could work to their strengths, contributing their best.
In some places this is already happening. Jim Whitehurst, author of ‘The Open Organisation’, explains how this was achieved in RedHat. But I am not sure where this is happening anywhere in healthcare. If you know of an example, please let me know.
