My friends and colleagues Jeff Stamps and Jessica Lipnack have made an art and science of studying complex organizations. Their particular focus is on how communication within and across networks of relationships either enhances or degrades a company’s ability to succeed. I recently looked at some draft work they have in progress, based on earlier work they have done. I think it is timely to share it with you (with their permission).
Jeff and Jessica raise provocative and timely questions for those of us implementing the Lean philosophy in complex hospital settings, or even for those who just are trying to manage in these kind of institutions.
In this long season of forced reorganization how are you facing complexity? Are you reducing or increasing your ability to make good decisions?
For the past thirty years or so, the prevailing wisdom about organizations is this: the flatter, the better. An inch-high and a mile wide. Smash the hierarchy. Nowhere was this more evident than in the corporate press release of the then-new CEO of BP. In October, 2007, Tony Hayward said his company was determined “to improve performance by simplifying how the company is structured and run.” While emphasizing that they have the right strategy and resources, he described BP’s problem this way: “…we are not consistent and our organization has grown too complex.”
Got your attention?
To remedy the situation, BP planed to adopt more standardized procedures and reduce the number of management layers from 11 to seven.”D What major benefit did Hayward expect to gain from redesigning the organization? “… [T]he revenue boost expected from greatly improved operational efficiency over the longer term.”
No one would argue that simplification is indeed more efficient, but here’s the rub: It’s not necessarily more effective.
Back in January, 2008, Jeff and Jessica privately predicted that Hayward’s BP reorganization would be suicidal. Now they say:
In light of the deep water explosion and gusher into the gulf that erupted on April 20, 2010, BP’s management structure is of vital, urgent interest as part of understanding what happened. Ominously, executives from BP promised Senators they would “fix” the management problems. If they do more of the same “reorganization,” they will compound an already disastrous situation.
Dogmatic global mandates, like one that says an organization must have no more than seven levels or that all managers should have ten reports (which a global financial management firm facing layoffs just executed), ignore other realities of business life. The number of levels your organization needs, or the optimal reporting span of your leaders, our research shows, is likely a function of what those units are actually doing.
Extensive study of one organization’s structure shows that some parts of organizations are shallow, others deep—depending on what they’re doing. Groups whose primary need is to communicate call for shallow structures that allow them to quickly spread messages; units engaged in complex decision-making require deeper structures that accommodate more specialization. The best structure fits the work at hand.
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Jeff and Jessica state that the “complexity of decision-making” is the primary determinant of the proper “depth” of management structures. But what about the acuity of tasks that these groups are asked to handle? Certainly this is also important, as hierarchical management structures lend themselves to swift, albeit more unilateral decision-making.
As a medical student within your academic affiliate, Mr. Levy, I see interesting parallels between this and medical team hierarchies. While the formalities of seniority of residents exist in all fields within medicine, they manifest themselves differently in each field. Internal medicine and psychiatry, for example, are effectively much more “flat” due to the need for communicating complex medical information on a less urgent basis. By contrast, hierarchical systems still predominate in surgery, where urgent situations are faced more often by physicians. And yet, both could benefit from some degree of managerial restructuring, as efficiency of care is sometimes compromised in the former fields, while cross-team communication is sacrificed in the latter. Both stand to benefit with a happier medium.
Please visit my blog on business in health care:
http://www.shereefelnahal.com
Any organizational structure will fail if perverse goals and incentives come from the top. Clearly BP would have failed to prevent this environmental disaster with 11, 7 or 2 layers of management.
MANAGED CARE
Managed care health insurance quotes and plans cover health services if received from selected providers and offer financial incentives for patients to use these providers. Instead of paying for each service you receive, coverage is paid in advance (“prepaid care”).
The three major types of managed health care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.
In an HMO, you’ll pay a fixed premium for you health insurance, as well as co-payments for certain services — for example, $10 for an office visit or prescription. Your out-of-pocket medical expenses might be low, as long as you use providers in the HMO network.
As a rule, you must receive your covered medical services through the plan. Generally, you’ll choose a primary care physician who coordinates your care, referring you to specialists when needed.
PPOs and POS plans combine features of fee-for-service insurance and HMOs. POS plans usually have primary care physicians, while PPOs don’t. Both types offer more flexibility than HMOs, but premiums will probably be higher. With a PPO or a POS, you’ll get some reimbursement for covered services from providers who aren’t in the plan, although it will cost you more than choosing a network provider.
Q: When is it appropriate to call 911?
A:
Anytime you feel you can’t respond to a medical emergency yourself, or safely transport the patient to the emergency room, you should not hesitate to use the 911 emergency system. Here are a few situations when calling for help is advisable:
Severe difficulty breathing, gasping for air or choking
Convulsions or seizures of any kind
Any severe injuries, including deep or extensive cuts
If a permanent tooth has been knocked out.
For any swimming accident where a child has been underwater more than a couple seconds
For burns larger than fist
For exposure to smoke or toxic fumes
For head injuries
For loss of consciousness
You call also call the Poison Control Center if someone has ingested any harmful substance: (800) 282-3171.
Every new management revelation should come with a mandatory grain of salt. Too often leaders looking for solutions see new concepts as a fork in the road: take it whole-heartedly or reject it completely. How about looking at it as a new insight, something the leader can apply as needed. Leadership is not picking the right philosophy, tool or paradigm. It’s finding the way that works best for the organization in the circumstances it faces, and being willing to challenge the decision to be sure it still holds value.