All is not as it appears.

12 08 2009

The recent gap in posting has been partly due to the large amount of work I have been putting into our degree assignment. This morning I (hope I) put the finishing touches to the wee beastie and popped it in a zip file. My paper is on “Engagement of clinicians and management in the NHS” and after considering the issue in terms of organisational structure, strategic planning and clinical leadership I do think I have some useful thoughts.

One of the principal causes of poor engagement is that, contrary to the Mintzberg classification of organisational structures, hospitals (or ours at least) are not being run as the professional bureaucracy that the clinicians expect but as a machine bureaucracy.

I appreciate that for some of my readers I might as well be speaking Polish but I am also encouraged that many people read this who are not approaching the topic from an in depth study of organisational taxonomy and yet show an interest and insight. I think it helps me to try and explain this (to myself) in different terms so I will try and do the same for you.

In a managed professional bureaucracy the “operating core” (clinicans) are the source of production and because of the specialised nature of what is produced (clinical care) the core have a large degree of autonomy, control over performance and are supported in this by the “strategic apex” (management).

A good example of a machine bureaucracy would be a factory with highly specialized, routine tasks; formalized procedures in the core; a proliferation of rules, regulations, and formalized communication throughout the organization.

Unfortunately, in the modern NHS the latter rings more bells than the former. Drives for performance, merged and centrally managed waiting lists, cross covering, out-sourcing, the lack of core professionals  influence or even be involvement in strategic planning, imposition of “guidelines” and “protocols” may be viewed as a move away from the autonomy and professionalism expected of a managed professional bureaucracy.

Bate proposes changing the culture of a hospital as the “experiment” of clinical directorates has failed. He may be right. What is sure is that the current structure is not as the operating core would like, nor as Mintzberg suggests it should be. Perhaps this partly explains the lack of engagement between clinicians and management.


Evolution or Intelligent Design; perhaps a unifying theory?

28 03 2009

One of the recent tasks on my course has been to study, in a little more detail, some of the work of a leading individual author on strategic thinking. I have blogged previously about Henry Mintzberg, a man with an engaging writing style, insightful thinking and what appears to be an honest approach to challenging the establishment view of his subject despite actually being part of its foundations.

In his monologue, “The Illusive Strategy…25 Years Later” (1993) Mintzberg references his first article, written as a doctoral student, way back in 1967 in which he highlights ideas that have spanned and defined his academic career; a comparison of deliberate and emergent strategy.

He wrote:

“Man’s beginnings were described in the Bible in terms of conscious planning and grand strategy. The opposing theory, developed by Darwin, suggested that no such grand design existed but that elemental forces gradually shaped man’s evolution. The disagreement between the Biblical and darwinian theorists is paralleled on a more mundane level in the study of strategy-making. There are those who envision grand calculated designs for the corporate entity, and there are those who cite current practice to argue that organisational strategy evolves, shaped less by man than by his environment.” (1967:71)

As we have worked through these concepts on our course I have gained some small insights into the complex world of strategic planning. As discussed in the earlier blog there is clearly a significant interplay in the set out and recorded, deliberate strategy and the final, outworked, emergent strategy. I wonder if the distinction between the two, as with concepts of evolution, might actually be an artificial construct of  the two theories each suggesting its own mutual exclusivity. Whereas the reality may more reasonably a combination of the two.


In discussion around evolution, darwinists are unable to explain without the use of hypothesis and teleology exactly why human kind, above all others, should have become pre-eminent whilst supporters of intelligent design struggle with ideas such as the extinction of dinosaurs. Neither of these facts negates the contrary theory.

In strategic theory it is clear that deliberate strategy is essential for the corporate entity, as Mintzberg put it, but it seems unlikely the emergent strategic result is totally independent of this and purely a result of the environment. The original plan, the effectors of it and the environment all bring about the eventual result.

Back to analogies- intended versus realised strategies on the football pitch

15 03 2009

emergent-strategyThe 1998 paper Mintzberg, Quinn and Ghosal (1998) looked into organisations with and without explicit strategic plans, the effect of this on the staff within the organisation and the ultimate outcome. Importantly, and intriguingly, the principal finding was that the realised strategy of the organisation was not directly related to the intended, deliberate strategy, the precise and explicit plan of the organisation, but more an outworking of the non deliberate and hugely variable strategies of the work force; emergent strategy.

This all sounds very complex until you put it into an analogy, once again I have returned to the football pitch.

The current manager of Albion Rovers is Paul Martin. Before a match he will gather information about his team, the opposition and their usual tactics, possibly even the weather and the referee, to come up with his intended strategy. His team will be briefed with this, given explanations about pressing plays and the mid-field width, the role of wingers and the man to man defence. This deliberate strategy is inculcated into the team right up to the point where they cross the white line.

courtesy Paul Reilly

courtesy Paul Reilly

And then it all falls to bits as Forfar change to the long ball game as the weather turns, worse still four players on the Rovers team get booked and with the  midfield failing to deliver their expected dominance, all this brings about the realised strategy of a 4 nil humping the likes of which they haven’t seen for a while.

The manager sets out an intended strategy, the team play out their own individual strategies, some in the knowledge and direction of the manager’s deliberate strategy, some not, and the realised outcome is a combination of all these; emergent strategy.

Sadly, the reality wasn’t what was the intended strategic goal!

The Four Arts of a Scholar – 四艺

23 12 2008

As I mentioned in a previous post, my nom de plume comes partly as an expression of my learning status; insei, a student.

The ancient Chinese believed that a Scholar needed to learn and study to be proficient in the four arts; qin琴, qi棋, shu书, and hua画  and thus become accepted in discussions amongst other educated men.  Importantly these skills themselves of playing a musical instrument, playing a complex board game, calligraphic poetry and painting were not the end point for the scholar. Acquiring these skills was a demonstration of the individual’s strength in reason, creation, expression and dexterity.

We recently watched a video presentation from MIT involving a discussion between Ricardo Semler and Henry Mintzberg in which the latter bemoans the current state of management and leadership. I intend to discuss a few of the points made in later blogs but concentrate in this on this concept of training for management.

Mintzberg comments in the video that he believes candidates for MBA courses should not be sought directly from graduate schools but from industry itself. He believes the candidate should have learnt the arts and crafts of their business by experience, progressed upwards through the organisation so that then, when training in management they might apply their own experience to their learning of management principles rather than take the learnt experience of others and apply it to a job they don’t understand.

The ancients (and I don’t mean Prof Mintzberg) appreciated that to take on such responsibilities one must have experience and understanding of  life expressed in “the four arts” before taking on scholarly pursuits and similarly Mintzberg feels that experiential understanding of the organisation is central to the training of a manager why then do so many clinicians in the NHS move directly into management with no formal training in what is clearly a complex and difficult task?

I believe I have learnt my arts of the scholar (ars longa vita brevis) and now I am learning the skills required for management and clinical leadership. I am being encouraged to take on a managerial role in my organisation without having any experience or training in such a task.  Should I do so and learn by my mistakes or is it better to listen to those with wisdom and first gain insight to then apply that knowledgeably?

I would value, as always, comments on this.

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