Så kan sjukvården testa nya idéer – innan de når patienterna

När forskaren Paul Holmström själv blev sjuk hamnade han mitt i det sjukvårdssystem han studerade, och såg ännu tydligare vilka förbättringar som krävs. Nu presenterar han sin licentiatuppsats, som visar hur systemdynamik kan användas för att utveckla hälso- och sjukvården. Grundtanken: att testa förbättringsidéerna i en modell först – utan risk för verksamhet och patienter.

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On the work and decision-making of managers

What do managers really do? What is the difference between managerial work at different levels and how do we get the right person in the right job?

It boils down to understanding what managerial work really is about. We get little help from psychometric instruments. Yes, we do know that there is a correlation between intelligence and conscientiousness and achieving results in a managerial role. So would higher scores on intelligence and conscientiousness imply greater ability for higher managerial positions? I have not seen any research correlating managerial levels with specific measures of intelligence etc. Psychometrics are used to differentiate between applicants, not between levels of work. What is it then that makes the difference?

Many of us had a good laugh in the seventies when we read Laurence J. Peters’ “The Peter Principle”, claiming that managers are promoted until they reach their level of incompetence. A good laugh most probably due to recognition of the fact that a significant number of managers are not good at their job and we recognized the described symptoms. The really interesting phrase is “level of incompetence”, implying that there are levels and that some people can attain higher levels.

There are plenty of descriptive expressions of when somebody is not doing the managerial work expected of them. In the UK one might say that somebody is not up to their job, has too much on their plate, is out of their depth or not up to the mark. In Sweden we can say that somebody is to short for their coat or that they do not have sufficient height. In Denmark they say that a person unable to fill his shirt.  Most languages probably have similar expressions. Again, the most interesting is, up to which mark, the size of the coat or the height that is sufficient, that indicates some sort of requirement, but of what? If we can pinpoint this, then we could probably avoid the effects of Peters’ Principle.

So how does the incompetence show itself? Primarily in the inability to make decisions. Decisions are what we do when we do not know what to do. If we are unable to cope with the uncertainty, ambiguity or complexity in making a decision, then we will not take a decision. The person will primarily avoid taking a decision, either hoping that it will eventually go away or that further information will let the decision make itself. When under pressure a person will make a decision anyway and it will be seen as being the wrong decision. Not knowing what to do and decide is a terrible burden. I have seen many managers flounder and agonize, not knowing what to do.

Interestingly there is another category of managers who do not take the right decisions, i.e. those that have done the job, grown out of it and should really have been promoted. Many who have outgrown their jobs lose focus. There is a lot of detail that needs to be considered and they may feel that they have seen it all. “This particular case is just like all the others.” People may see this person as unfocussed and not doing their job properly and will see little difference between the incapable person described earlier.

Colleagues in Bioss have done management audits in a number of organisations. Just over a third are well placed and doing a job at their level of ability. One third have been over-promoted and in Peters’ words reached their level of incompetence (no wonder the book sold so well) and less than a third could be doing the work one organisational level higher. There is no great shortage of potential managers, almost half of those at the first managerial level could be working higher up. The serious problem lies at the strategic level, where about half had reached their level of incompetence.

Bioss is now an international consultancy with about 200 partners, consultants and associates. We were originally a research institute at Brunel University, where a “scale” was developed to measure managerial work. The major difference between levels is that of uncertainty and complexity. Most people can within a very short time-frame see if their decision was right or wrong. At the highest levels the results of a decision may not even be seen during the tenure of the decision maker. How do you then know in which direction to go? What is the difference between those that succeeded in those decisions and those that fail?

In the very early research it also became clear that many organisations have to many levels. Bioss describes seven levels of work that add value to the organisation and its clients/customers. Too many levels detract value. If the organisation has too few levels then there is work that needs to be done that will not be done.

These are the seven levels that we describe, most jobs lie within the two first. Here short descriptions:

Quality – This is where we find most of the people in organisations. They are the persons that we usually identify the company with, such as bank tellers, car workers, postmen etc. These are the people that do the work that provides the income and profits of the company. Their job is to do a good job with quality.

Service – Here we find both first line managers and specialists. The job of the manager is to give service to their employees so that they can do the quality work. Many first line managers talk about how they juggle their work, they need to ensure quality, have an organisation in place, schedule staff, ensure customer satisfaction, productivity, a good work environment etc. The specialist birings their deep accumulated knowledge into their jobs.

Practise – Here is operational management – a small to mid-sized organisation, people, plant, resources, budgets etc. The job is to create a work system. Which is the most efficient structure, system etc, both now and for the immediate future?

Strategic development – At this level in the organisation we usually find a functional or geographical structure. Here are people whose job is to develop strategy within their areas and spend more time and energy considering where and how value will be created in the future and less time on running large operations.

Strategic intent – This person will be leading a large company within a well-defined business. In a large corporation this will be a strategic business unit. The job is asking the existential questions “Where is this business going?”, “Why are we in it?” in order to ensure the financial and social direction and viability of enterprise.

Corporate citizenship – These are probably the people that we find at the World Economic Forum or Aspen Institute. They are making sense of the world and are sensitive to changes that can be seen and be responsive in building strong local, national, regional and worldwide presence.

Corporate prescience – Here are the very few people who somehow seems able to go beyond visible trends. It is as if they are gazing into a crystal ball and see possible futures and take steps now, the full effects of which may 20-50 years to be seen and understood.

Of course we have considerably longer descriptions of both the jobs and what people actually do in their roles at different levels.

I very often find that managers strongly relate to and understand these descriptions. Higher managers directly sense which of their subordinate managers are doing their job or not and

People have different strengths and develop differently over time. I ascribe status to a person that does a job well. I can be amazed looking at a gardener. When I go to our favourite sourdough bakery I look at the skill and energy-efficient movement of the baker. I am disappointed when I meet a manager who has reached their level of incompetence. Some people become immensely skilled bakers, footballers or violinists over time. In Bioss we are interested in managerial career paths. We see that some people follow paths that may lead them to very high managerial positions. Some of the early research at Bioss was sponsored by the US Army wishing to identify potential four-star generals and put them on more rapid career path development.

Bioss developed a method, which we call Career Path Appreciation, in order to “predict” such development. Better to promote on potential than past history, as the latter may lead to filling jobs with people who already have done it and have matured out of it. Longitudinal studies show that we are able to “forecast” with more than 80% precision in a 7-10 year time frame. Long enough to ensure than a person is not promoted to their level of incompetence.

Quite a number of people are given a job based on their track record and proven ability to deliver at that level. The risk is that they have outgrown their past and should really get a job one level up. I have often seen how people like this after 6 months realize that they have done a lateral move and there is no challenge in what they are doing.

Some companies and organisations have worked with Bioss and Bioss methods for decades. You can see a list of some of the international clients at http://bioss.com/about/our-clients/

Strategy or culture first?

In answer to a question on LinkedIn: Strategy or culture first?

It is like the hen or egg question. Drucker wrote that culture eats strategy for breakfast and Schein wrote that you will not understand the culture until you try to change it.

Culture can lead to the failure of strategy. Cultural change without strategic direction is a waste of time and energy.

So in a sense the first step is considering ideal long term strategy, where do we want to be in 7-10 years. What are the cultural impediments? Which steps can we take within the existing culture? Which cultural strategies do we need to pursue over time so as to create the preconditions necessary for reaching the long term strategies.

Many years ago I worked with a CEO working with culture and direction. Over three years three distinctive steps were made in organisational structure as the organisational culture matured. The banner goal of the company was developed early on and was not changed. But strategy evolved over time.

Culture is like fish in an aquarium. Most fish tanks have fresh eater, are oxygenated, regularly cleaned etc and the fish thrive. Some aquariums are in a dire state and the fish are sluggish if not dying. But they do not come knocking at the glass drawing your attention to the problems.

I have been in many organisations where people are aware that culture is in the walls, but they cannot diagnose the culture and definitely not identify any changes needed. Many changes in strategic intent fails as top management does not understand the importance of the social processes and actually do not know how to build a strategy for the strategy and implement it.

Suger de vanliga jobben allt mer?

Richard Florida lär hävda att problemet är inte kvantiteten arbetstillfällen utan kvaliteten i arbetena. Steve Denning har skrivit ett bloginlägg om att jobben suger. Inte mindre än 84% av alla arbetande amerikaner vill byta jobb under det kommande året. Dennings analys är att jobben suger och att det redan nu behövs radikalt ny management.

Enligt Svenskt Näringsliv vantrivs 350 000 svenskar på jobbet. Deras analys är ur ett arbetsrättsligt perspektiv – LAS innebär att man drar sig för att söka nytt jobb. Enligt tjänstemannaorganisationerna så vill 1/4-1/3 av alla tjänstemän ha ett nytt jobb det närmaste året.

Det kanske är tecken på att även vi i Sverige skulle behöva ny management och nya organisationsformer.

Does a manager’s personality and values affect job performance?

In one sense a manager is paid to do the job and act and behave in such a way that goes with the job and company policies. What the job is and which behaviors are required should be very clear.

A person considering a job as a manager then needs to assess his/her own personality, preferences and values and as if they want to do the job as required. If not look elsewhere.

A manager and his/her manager need to have conversations to ensure that there is a match between the required behaviors and what the manager wants to do. If there is a mismatch, then that will impact job performance and they need to handle that and maybe consider separation from that particular job.

(This is a response to a question posed at LinkedIn)

Why do we have Matrix organisations?

This is a response to a LinkedIn question.  Forrest Christian suggested in a comment to another post that I post my responses here as well. Those of you are LinkedIn members can read the whole question and all other answers here .

My answer was:

No matter how a company is organized formally, for stuff to get done people need to communicate and work across boundaries. Researchers have done social network analysis in organizations and have seen that some bosses cannot handle this; they force everything to go through them, so of course they end up being bottlenecks. 

My belief is that matrix organizations were “invented” to address the non-cooperation between unit managers. But we still have a lot of turf wars and alpha-male behavior. We also see organizations apparently in endless committee meetings. 

My opinion is that matrix organizations were a “quick fix” to a larger and more deep-running problem. If we “solve” those problems we will not need matrix organizations. Managers needs to be selected ,trained and rewarded for abilities to: 

  • work with talented staff who do not need constant direction 
  • being able to work in collaboration and yet be held accountable 
  • that company results are more important than personal position