Managerially, things are a little “difficult” around here. Recently we were invited to our first ever ”Strategy Meeting” to which I went, trying to be positive and viewing this as a sign of progress and engagement. Sadly itwas actually just an opportunity for senior management to tell us how bad things were and how “we have to make big changes that had already been decided otherwise we will not achieve Foundation Trust status and this will be a bad thing for us.”
I have commented previously on the nature of engagement between clinicians and management and particularly around the nature of organisational structures, as described by Mintzberg. The present feeling is that hospitals are managed professional bureaucracies (mpb) in which the “operating core” (clinicans) are the source of production and, because of the specialised nature of what is produced (clinical care), have a large degree of autonomy and control over performance. They are supported and to some extent directed in this by the “strategic apex” (management).
In light of our recent interactions I am beginning to question this classification. Previously I have suggested that rather than a mpb, hospitals are becoming more akin to a machine bureaucracy (mb) such as a factory characterised by highly specialized, routine tasks; formalized procedures in the core; a proliferation of rules, regulations, and formalized communication throughout the organization.
What struck me in our “meeting” was the frequent use of inclusive words such as “we” and “us”. Now, regarding this as more than simply management speak, of which I am heartily sick, and sadly also the insincerity with which we are frequently faced, it is clear that the management approach is based upon the concept of a team working in a united manner towards a common goal. This is to be praised and valued. Sadly this is patently wrong on many levels.
The operating core does not share the stated strategic goals of the bureaucratic apex. In the worsening financial climate with calls for “efficiency savings” in the face of four years already attempting such, the fact is that these new strategic aims are diametrically opposed to those of the core and possibly their fundamental belief systems. Even the most liberal minded strategist would see that rather than the example used previously of an emergent strategy as being the joyful union of intended and deliberate strategies what is about to occur is discordant, divergent strategy. This would be almost impossible in a managed professional bureaucracy and untenable in a machine bureaucracy.
Moreover, the operative core has recognised that “management failure,” in whatsoever guise this occurs, will not bring about apocalyptic destruction or failure of the bureaucracy (hospital), merely a change albeit dramatic and possibly total, in and of the strategic apex. Complexity theorists should watch this space, we have serious disequilibrium.
Consequently, the nightmare scenario painted by the apex of “failure” for us is actually for them and holds few concerns for the core. It may even bring dramatic improvements. This failure is almost inevitable, not simply because of the financial crisis, but due to an instrinsic failure in the understanding of machine structure.
