“The problems that exist in the world today cannot be solved by the level of thinking that created them.” Albert Einstein
Putting clinicians into management roles should be regarded as a strong move to reintroducing organisational hygiene in the health sector. How so?
Because the root cause of the problems in most of the health sector is that those who do are not permitted to plan.
Targets are set, and managers manage to meet them.
What’s wrong with that, you ask?
Several things.
First, arbitrary targets imposed on a system introduce inefficiencies in that system. And any targets imposed from outside are necessarily arbitrary. So the more successful managers are at meeting targets, the less efficient they are being. The managers tasked with meeting these targets are actually helping make the system worse.
Second, by seeking efficiency at a unit level – by specialisation – inefficiency is introduced in to the overall process. Why?
Because the throughput of one unit may be faster than the unit that receives the patient afterwards and this introduces a bottleneck in the process, think of the backlog at any Radiology department, for example. Patients are required not only to be on a waiting list for their specialist appointments but also for the diagnostic tests needed for those appointments. So setting targets for specialist appointments without taking into account the other services involved in providing the information needed for those consultations simply introduces more inefficiency.
We have enough efficiency
Third, targets are a symptom of an efficiency mindset. Which is a manufacturing concept: throughput, units per hour, cost per unit, bed days, visits per clinician, etc.
But efficiency is self-limiting. There are only so many things you can do in an hour, or for one hundred dollars. After that, you need to look for other ways of adding value. And in a service industry, value is added through effective interventions.
The health sector is a service sector. And efficiency is the wrong focus for a service. Let me explain.
The manufacturing industries are based on taking raw materials and transforming them into finished products. Efficiency is crucial in this environment so as to keep operating costs down, thereby increasing profit. Very straightforward micro-economics.
Service, on the other hand, is concerned with solving client problems. The measure here is effectiveness, and the only person who can measure that is the client. In the health sector, the patient.
By focusing on effectiveness, the emphasis changes from time to relationship. The most important thing in the delivery of health services is the relationship between the patient and clinician, all processes and systems need to support that in a service environment.
The funny thing is that by focusing on effectiveness, the system actually becomes more efficient. Without any outside tampering.
Putting clinicians into management roles will help to keep prying fingers out of the management of our health services. And that’s got to be a good thing.