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6 July 2012
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The End of Management

This blog post gets its context from Alan Murray’s ‘The End of Management’ Corporate bureaucracy is becoming obsolete. Why managers should act like venture capitalists; in the WSJ,  please read it before you read this blog. You can read this either as a commentary of the WSJ article as relevant to NHS or on its own.

We are the management and we will tell you how to end management!?!?!

At a broader level, in the NHS there are no examples that I can think of where corporate structure or management has been ‘ended’. However, the government is trying to get us do differently. But that is what modern business is trying not to do; modern thinking in management is not telling people what to do but to let people to do things first and the management to amplify the good ideas.

The combination of very individualistic approaches to healthcare and the kind of people who are drawn to public services (possibly risk averse, change shy, rule-bound, authority loving, service minded and so on) and it would be difficult to use the same methods as for instance in Google to achieve a new management approach.

Healthcare and NHS is thought to be too important and too costly to be creative or innovative, the phrase used is 'risk'; with too many central and external controls. It may seem like the message of WSJ article is not applicable to UK healthcare. But there lies the opportunity as well to ‘end management’ and create self-sustaining systems.

Blue skies

Hence, I can now boldly enter the imaginary world to explore how to ‘end management’. I think the way to do it is to disengage from current conventions and demonstrate its success. That does not mean rebelling, non-cooperating, behaving illegally, becoming disenchanted or any such thing. It is using our own methods to satisfy our requirements and our clients’ requirement rather than using a method or doing a thing to satisfy an external definition.

For instance when the roads around Birmingham were choking, they opened the hard shoulder to traffic which in other roads is actually illegal; peak time traffic situation has improved since in that area.

Like the Birmingham roads, what 'illegal' things could we do to make ourselves better?

Is this an example of wisdom of the crowds in the real world of healthcare?

Finally let me try a hypothetical yet hopefully practical proposition. There is a focus on Unplanned emergency re-admissions and we may not get paid for such re-admissions. Here is a potentially disruptive solution:

a) Not offering routine follow-ups for any patient who is discharged from the ward (medical, surgical, post-operative)

and instead

b) Guaranteeing a clinic slot within a defined time (48 hours to one week as agreed) should the patient choose to contact us.

This approach may reduce unplanned emergency readmissions. Okay, where is the 'wisdom of the crowd' here? The crowd in our example are the patients; and the wisdom is the patients’ knowledge about their own health. This is of course one step further than the current thinking on 'crowd' which is usually the employees.

Threads of new systems

We can predict that the conventional management methods will not work in the 21st century. End of management as we know it is not chaos as many would like us to believe. There are emerging themes; democratisation of data, data mining, crowd sourcing, coping with anti-knowledge, cloud care and dumb-terminals, many more............ It is not these themes that are important; it is how we implement these themes that are relevant. We can be told how to do it thus not ‘ending management’ or we can show how we do it.



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About the author

Makani Hemadri's picture

Makani Hemadri

M Hemadri is an Associate Specialist in General Surgery and Clinical Innovation and Improvement Lead at the Northern Lincolnshire and Goole Hospital NHS FT. He spends half his time on matters such as system and clinical quality improvement. He was a Fellow of the NHS Institute for Innovation and Improvement and a Leaders for Change award holder from the Health Foundation.

He is one of the 1.4 million employees who have strong views and are all passionate about the NHS. Of course all of them including him are always right. Hemadri only wishes we genuinely agreed with each other more often.

[Biography supplied by the author].


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