Wednesday, March 11, 2009

Systemic crisis of failed management

Paul Fitzgerald, a former health advisor for the New South Wales Government, writes in The Australian newspaper that the Australian health sector is suffering from a systemic failure of management.

Paul's argument is that the delivery of health services is mismanaged due to non-clinical managers with a focus on financial management having control of hospitals, rather than clinicians themselves having management control. Paul also argues that poor management leads to higher turnover of all staff, the best leaving the industry, mediocre performance by those remaining and in Paul's, opinion, low standards of health care for the consumer.

Paul makes a number of other arguments in his article related to the efficiencies of health service delivery however I wish to focus on the management aspects. The first realiy of public health in Australia and New Zealand is that every manager must learn to deliver a service within budget and political constraints. Having to achieve this is not the cause of poor management. Managers are people and they work with people. They are ineffective as managers when they make poor decisions about people without regard for the people they work with.

Yes public health providers are professional bureaucracies, as are all Government funded organisations, and yes bureaucracies have their share of poor performers, as do organisations in the private sector. The challenge for management is to achieve the best from each person within the resources avaialable. Highly effective managers do make a career choice, they do seek to engage in management practice and as such they make a commitment to manage effectively.

It is erroneous to assume good clinicians will also be effective managers of people. They may be able to identify supply and demand and they may be able to adjust service delivery to meet demand yet if they fail to manage and develop the people that work for them then the outcome will remain the same.

The funding challenge for the public health sector is two-fold; firstly to adequately fund clinicians, equipment and facilities and secondly to adequately fund the development of management. Effective managers, clinicians or otherwise, with a good understanding of health processes, a well developed ability to get the best from people, an understanding of patient needs and the ability to manage within financial constraints are the key to high quality health care delivery at the lowest cost.

Research conducted in the USA from 2002-07 amongst 200,000 people from 500 health service providers, and published in a white paper by Success Profiles, titled Organisational Culture and Performance in Healthcare Organisations, clearly illustrated the relationship between effective management practices and operational efficiencies. The message was clear, develop your management capacity and capabilities. Develop the ability of your managers to lead and develop people. Hire the right people with the right skills to do the right job.

Let The Journey Continue
John Coxon

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Andrew said...

Hi John,
What I'm reading in your definition of undeveloped management competency is actually undeveloped leadership competency. Clinicians are often exceptional (project, program, etc) managers, but lack as (human, organizational) leaders.

Kotter describes the difference between leaders and managers well in Leading Change.

Leadership is in great need here in North America as well. An understanding of living systems should provide healthcare professionals with a head start in understanding organizations and leading amidst complexity. Providing the resources necessary is the challenge.

If the resources exist, is time and $ invested in putting them in the leader's hands?

JC said...

Andrew, thanks for your input into this discussion, good to hear from you. I agree with you in that it is undeveloped leadership.

I believe the missing element is the ability to operate together in a truly collaborative manner - for the better of the entire organisation.

Collaboration starts with conversation, with sharing of information and with a common understanding of issues.

If we envisage a tree growing in a forest, first you have the soil, where seeds (ideas) are found. Through a series of events germination takes place. Then a root system is formed (team) for the purposes of extracting nutrients and providing support. A trunk forms, providing strength, direction and a framework (processes). The sun shines, foliage forms and flowers blossom. Birds (us people) extract sustainance, pollinate and drop seeds back into the soil. It is a cyclical, holistic and symbiotic process, whereby should one part of the organisation fail then the entire system is doomed. (

In the Tipu Ake model, leadership is shared, drawing upon the strengths of all those in the organisation.

Let The Journey Continue
John Coxon