This reflection was originally posted on Linkedin on July 26th, 2021 by Kurt Nielsen.
In my first reflection this summer I shared positive experiences with a certain branch of the Danish health care system; how come this is unfortunately not a universal experience? Recently other experiences have surfaced in our circle of family and friends that point in the opposite direction. Why does the same system – in this case – the health care system, produce departments with close to opposite priorities?
The experiences can be summarized in the following bullet points:
- A psychiatric patient was overruled by the lead psychiatrist with respect to both medication (which she knew would make her addicted) and therapy sessions with people that had previously scared her. This was the procedure they follow, end of story!
- A child in urgent need of attention to various social and learning challenges has for years been sent through endless hoops of absurd questioning, irrelevant surveys and procedures plus numerous handovers from one person to another, with a total restart of the process. For the family and the child it has been deeply disturbing and patronising, revealing that the people in the system lack the most basic empathy and understanding of how to deal respectfully with people. “But my forms require me to fill all this out” is about the best answer to be had.
- Several elderly people in need of care, some terminally ill, received totally inadequate, late and seemingly uncoordinated attention. When family members tried to intervene, they were brushed off harshly with a: “these are our procedures”.
- Following a recent surgical procedure, an official petition for eight weeks’ sick leave was filed, automatically triggering a flurry of needless activities with meetings, action plans and the involvement of consultants, all with no apparent aim in mind. Again the baffled patient was offered the bland answer: “but we just follow procedures”.
What is it that makes seemingly grown up and intelligent people persist in activities that are at best absurd and funny and at worst, deeply harmful to weak and vulnerable people, reaching Kafkaesque proportions of absurdity.
My take is that the problems are related to the system in each department, not the individuals working there, according to W. Edwards Deming:
The system that people work in and the interaction with people may account for 90 or 95 percent of performance.
By extension, then this is a problem related to leadership, those with the authority have to change the system or co-develop a better one with the people on the frontline. Almost certainly these people in leadership positions see themselves as managers of rules, regulations and systems and not leaders with a mission to help the organization create value.
It seems that it is much easier to create a set of rules and key performance indicators and follow up on their compliance, than it is to assess the outcome of our activities with the client, the customer or the patient. In many cases – and certainly in the ones mentioned above – the organization oozes hierarchy and power. The people upstairs are expected to know best, and those downstairs are expected to obey and comply. W. Edwards Deming said:
If the boss becomes the customer, who takes care of the real customer?
In such an organization, it is almost unavoidable that people “please upwards”, “present the truth in its most favorable light”., Tthis is due to the equally unavoidable presence of fear in such an organization, the boss holds the future of the subordinates in her hands as General Stanley McChrystal said about the army:
You either move up or you move out!
Decisions are made on strongly filtered information, as only those bits that people think will please the boss are relayed upwards. People don’t want to lose their jobs or be penalized, so they take a back seat, shut up and follow procedures – or leave. Many have never seen anything else and hence cannot imagine that it could be changed. Brigette Hyacinth has this to say about it:
The biggest concern for any organization should be when their most passionate people become quiet. Read more here…
What to do about this huge difference between the results of one team or department versus another? It is of course not just a problem in the healthcare system or even the public sector; many large corporations display similar traits, especially in the accounting or so-called customer service departments.
Leadership has to allow a change in the system of how work is managed, decisions made and feedback handled. Which means abolishing the traditional upstairs, downstairs thinking with hierarchical management and instead, institute leadership and retraining or replacing people in places of authority. Stanley MacChrystal said about the huge difference in effectiveness of the battalions of his 82nd Airborne Division:
“Switch just two people – the battalion commander and command sergeant major – from the best battalion with those of the worst, and within ninety days the relative effectiveness of the battalions will have switched as well,”
He also said about his own role in changing leadership style in the face of complex opposition in Iraq, that he had – at the ripe age of 50 – to change from being a chess master to a gardener:
The temptation to lead as a chess master, controlling each move of the organization, must give way to an approach as a gardener, enabling rather than directing. A gardening approach to leadership is anything but passive. The leader acts as an “Eyes-On, Hands-Off” enabler who creates and maintains an ecosystem in which the organization operates
How do you think of leadership?
- A privilege or a duty.
- An entitlement to fulfil your needs, or as a duty of service to build up others and serve their needs.
- A right to demand compliance to your way, or a duty to facilitate common understanding and commitment.
In the end it boils to the simple premise: do I see my fellow human beings – employees, customers and colleagues – as objects of exploitation or as fellow travelers on life’s path, to be served and built up to their maximum potential.
I would encourage you to read Stanley McChrystal’s book “My Share of the Task”, it says a lot about leadership. Together with a group of agile and Scrum trainers and coaches we have created the framework Agile Lean Leadership for scaling Scrum from a single team out in the whole organization, the framework provides sensible constraints on how to have teams work together and checks and balances to ensure that any tendencies to go for amassing power or building unnecessary bureaucracies can be caught in their embryonic stages – small vipers are easier dealt with than the big ones. Let us help you implement this.