Bureaucracy Is Keeping Health Care from Getting Better



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bureaucracy, Bureaucracy Is Keeping Health Care from Getting Better
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In a recent article, Gary Hamel and Michele Zanini detail the toll that growing bureaucracy is taking across industries. Many of those working in the consolidating health care industry will immediately validate several of the authors’ key findings, including:

  • Bureaucracy is growing, not shrinking.
  • Bureaucracy is destroying value in innumerable ways, including slowing problem solving, discouraging innovation, and diverting huge amounts of time into politicking and “working the system.”
  • CEOs are substantially less likely than frontline staff to see bureaucratic barriers in their organizations.

I’ve seen many health care organizations where the clinicians and other frontline staff who actually help patients are subject to increasing numbers of fragmenting directives from above and are forced to devise work-arounds to cope with ineffective problem-solving systems.

What about solutions? Hamel and Zanini declare that there is “no map to disassembling bureaucracy.” I beg to differ.

Great organizations across industries fight bureaucracy by explicitly structuring their leadership systems to connect everyone in the organization to the issues that the front line is encountering every day. They carefully define the roles of each layer of leadership to include supporting the rapid solving of frontline problems and developing those under them to do the same. Designing and actively managing their systems of daily operation (production), management, and improvement with this clear intention to fight the wastes created by bureaucratic behavior becomes the core of their competitive advantage.

Two cornerstones of this approach provide clear examples of how to fight bureaucratic bloat: lean daily management systems and a real-time problem-solving approach to eliminating workplace injuries.

Lean daily management systems were pioneered by Toyota, Honda, and other manufacturers. As John Toussaint, the CEO of Catalysis and the former CEO of ThedaCare, a health system in Wisconsin, explains, such systems, when designed and operated effectively, ensure that every leader has explicit work that they must do every day to help understand frontline problems and improvement opportunities….