By Stephen Dorrell, Healthcare and Public Sector Senior Advisor, KPMG in the UK
Medieval humanity is supposed to have believed that the status quo was permanent. Leaving aside the historical argument (were human beings ever so compliant?) the undoubted lesson of the centuries since the Renaissance is that a process of continuous change lies at the heart of human progress. Societies and institutions which try to insulate themselves from the change process quickly render themselves obsolete.
All organisations need to challenge themselves to be open to new ideas and new opportunities. Change is not an event which is completed; it is a way of life which is continuous and successful organisations aspire to adopt faster than their peers.
Change in healthcare is the result of many drivers. Every new treatment creates changed patterns of service, and changed patterns of demand. Furthermore healthcare, like all other activities, is affected by broader technological change (e.g. in information technology) as well as by changing consumer expectations and changing social attitudes.
Faced with these complex challenges the key requirement is to ensure that healthcare organisations understand the changing world in which they work. They need to understand the many technological influences on healthcare, but they also need to understand the needs and the wishes of the individuals and communities who rely on their services.
Over-centralised organisations fail because they voluntarily disable themselves from responding to these challenges. By centralising decision making they guarantee that decision-makers are divorced from the sources of the information they need to make optimal decisions.
Key messages, which frontline staff understand, are “lost in translation” as they wend their way through uncomprehending tiers of middle management. Furthermore the over-centralised organisation embraces two additional risks; by over-emphasising the value of orthodoxy it systematically undervalues the wishes of the different individuals and communities it serves and it fortifies itself against disruptive new ideas.
Management may try to invest in improved internal communications to combat these effects, but in doing so it is missing the point. Quite apart from the fact that the perfect conductor is unknown to physics, and there is certainly no human reporting system which is capable of transmitting information without distorting it, the controlling manager always underestimates the extent to which central control disables local initiative.
Instead of seeking ever more control, management should define the objectives of the organisation with clarity and appoint local leadership which is committed to deliver those objectives. Then it must provide local leadership with the space to act. Failure to observe this basic rule reduces local leadership to mere agency. Managers become courtiers whose concern is to “manage upwards” rather than deliver the objectives of the organisation.
Most importantly, senior management should recognise that in a large organisation diversity is often evidence of challenge and innovation. Their objective should not be to suppress diversity but to celebrate innovation while maintaining a focus on outcomes and acting to challenge outcomes which do not match the best.
It is ironic but true that healthcare organisations, which explore the frontiers of biological science, sometimes have a poor understanding of the principle of evolution.
Maybe some of their leaders should re-read Darwin!
This article represents the views of the author only, and does not necessarily represent the views or professional advice of KPMG in the UK.