In his famous book "Good to Great ” Jim Collins (*) writes, rightly, that an important task
for the top management of large companies is to keep the pressure of the
stock market outside of their company and its policies. Allowing this pressure leads to short-term
decisions, an excessive focus on making a profit, poor customer relationships,
manipulation and fighting symptoms.
A similar problem is visible in the healthcare sector. Only the harmful influence of the stock
market is replaced by the pressure of the political bureaucracy. This central power excels in increasing
the pressure on institutions, with some negative characteristics that threaten
quality.
Because it is a political environment, the decisions
and priorities are determined by 'outsiders'. In one legislature, politicians are
responsible for the environment, for example , and for social affairs in the next. It all depends a bit too much on the way
in which political parties divide the available seats among the mandataries who
can claim a seat according to their election results. As we know; "Participation without insight leads
to statements without prospects." That problem is exacerbated by the
distance between the policy level and the decision-makers and the political
game that influences decision-making (giving and taking in a power structure of
party interests and short-term thinking).
On top of that comes the bureaucratic reflex. The government has never been able to
prove itself as a model of good management. Outdated management concepts are too much a
part of the policy culture and make the entire operation centralistic, uniform,
procedural, ... All the principles from Taylorism can be found there as an infection
in policy implementation. The pressure on demonstrable achievements, texts about
what should happen and what happened, draw the institutions into a planable and legal context. More and more systems have to be
introduced to make all activities so-called professional, but they use concepts
that have been critically replaced, even in private companies, by more organic concepts and methods that
focus on empowerment, self-management, learning, etc.
The irony of the situation is that it is precisely in the
healthcare sector, given the nature of the assignment, that a much greater need
for a more modern approach is needed. Quality in care and education is not made
by more formal systems and standardized control. On the contrary. OK, then the trend towards tilted
organizations and the associated organizational innovation is a good thing! Right! But the internal tension in the
institutions between this healthy evolution and ambition on the one hand and the
outdated policy vision and management of the government on the other hand, is
becoming more and more pressing.
Institutions find themselves increasingly
compelled to organize and monitor everything in a more factory style, while at the same time
involving all their department heads and coordinators. That split leads to a loss of quality and
a lack of focus on educational and therapeutic development in the institutions. The pressure on staff becomes high,
resulting in a contribution to the burnout phenomena.
The management of these institutions should therefore
practice a modest dose of civil disobedience, in order to try to lower the excessive, and sometimes erroneous pressure from above
and, where possible, keep it out of their organization. That is not an easy exercise, given the
financial power of the government.
"I cannot hear what you are saying, because what
you are doing is speaking so loud!" ( Chinese saying )
(*) Jim Collins, Good to Great, Business Contact,
Amsterdam, 2004
Hugo Der
Kinderen
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