The hierarchical model, a burden

Jordi Varela

Editor

The current hierarchical model is slowing the good progress of companies and, to support this statement, I will stick to the evidence, through two different sources, one Japanese-Dutch, the iceberg of ignorance, and the other English, the cost of silence.

The iceberg of ignorance

In 1989, a consultant, Sydney Yoshida, carried out a study (reported in a Corporate Rebels post), for Casonic, a Japanese car company, and found that the real problems of the production lines, known by 100% of the operators, are captured by 74% of the team leaders, but only by 9% of the intermediate managers and by a scant 4% of the executive directors, who end up making the budgetary and investment decisions of the production chain. This surprising phenomenon of isolation and impoverishment of organizations was called the iceberg of ignorance. 

The soul of healthcare institutions

Professional groups, just like any other groups, have a soul or, as they now like to say, values. But whenever they try to write down these values, every group finds it difficult to find the words that express what unites them, what makes them say: "This woman/man will succeed, she/he’s ours." When professionals are immersed in a stimulating project or when they work in a team, it takes only a few words to understand each other, most people know this feeling especially when contrasting it with the feeling they get when they perform a job that doesn’t interest them so they end up literally counting the hours until the end.

"The Sprit of the Clinic"

There are few health institutions that have put effort into preserving their soul, being aware of how values are prone to oblivion and of how little the excellence of a unit lasts when effort goes unrewarded with the arrival of a new boss who sees things differently from how they are. For this reason, I have always admired the consistency of Mayo Clinic governance. It’s an institution created in 1892 by the Mayo brothers that has successfully overcome two major challenges: generational change and the entry of foreign capital (for more details see post of June 23, 2014). We must mention that, in recognition of the Mayo Clinic, most comparable projects have not overcome the challenges posed to the survival of values in the US or anywhere else. And how did the Mayo clinic do it? The answer is as simple as it is complex: "The Spirit of the Clinic" determines professional careers and the professionals’ progress; on the other hand, there’s nothing too different to how the great religions have survived over millennia.

Professionals are important, but so is good governance

Professionals in health services are important because without their dedication and enthusiasm patients do not receive the necessary care, especially in times of cutbacks. However, we should not forget that for these professionals to work properly they need their organizations to be well governed and I will exemplify this with two publications, the first of which is the last book of the veteran professor of McGill University Montreal, Henry Mintzberg, and the second is an article on this subject in the New York Times.

One of Professor Mintzberg’s best known lessons has been the conceptualization of the third sector as a balanced element of democratic societies. One sector, he says, called to serve as a counterweight between public and private spheres. Its key differentiator is property that is either collective, such as in cooperatives or is diffuse, such as in foundations or associations, apart of course of their altruistic purposes and their natural space: community services. All this makes the third sector is specially equipped to manage health services in a well weighted basis between the despotic temptations of political power and the interests of private companies.

Governance in healthcare institutions Debate at CSC and IESE

Next Friday March 21st, the Consorci de Salut i Social de Catalunya and the Center for Healthcare Innovation Management at IESE will hold a public debate about governance in healthcare institutions following the presentation of a document written by a team of experts and a complementary study from University Pompeu Fabra.

The event arrives in the right time according the current controversy between transparency and efficiency in public institutions. Those interested in this topic will find a good incentive to attend on the 4 main elements of the program: