This blog has been sadly neglected in recent years, as all my blogging time and energy have been taken up with my Brexit Blog. But the current coronavirus crisis prompts me to return to it, because so much of what is happening in this crisis has an organizational dimension, and some of it relates directly to the themes of the book which this blog accompanies. In this post, I’ll discuss some of them, with the focus on what is happening in the UK but no doubt at least some of it has a wider relevance.
Overall, it’s possible to see many of the chickens of contemporary organization coming home to roost. This is most obvious in the National Health Service where spending as a percentage of GDP effectively flatlined between 2011 and 2019, and per capita is well below that of most other highly developed countries (e.g. France, Germany, Japan, Australia). Crucially, this is against the background of a rapidly ageing population and – as has also been laid bare by the coronavirus pandemic – a social care system that was already in crisis and has been for at least half a decade (as discussed on this blog in May 2016).
The issues here go well beyond those of funding, though. They also relate to managerial apprehensions of the ‘efficient’ use of that funding. In the book (p. 142) I use the specific example of the NHS to discuss this, writing that “one way this has been done is to reduce spare capacity in the system. This in turn has the effect that unusual peaks in demand, such as a major incident or a flu epidemic, swamp the system … the question still remains: efficient for whom? Is spare capacity inefficient from the point of a view of a patient caught up in a demand peak?”
This seems almost prophetic now, as the NHS faces a desperate struggle to obtain the machinery and protective equipment needed to deal with coronavirus, whilst old people dying in care homes are not even included in the official coronavirus mortality statistics. Of course, it would be absurd to argue that any health system could permanently maintain all of the spare capacity needed to deal with so unprecedented crisis. But running a system for years without any spare capacity at all was always bound to lead to disaster.
Similarly, we are now seeing the consequences of the endless restructurings and in particular the dynamic of centralization-localization as the supposedly inefficient bureaucracy of the NHS is subjected to almost yearly reforms. It was such an analysis which led to the fragmentation of the NHS into Clinical Commissioning Groups (CCGs), to break down the ‘monolith’ of the NHS. This was happening even as it was being reported that the problem with NHS procurement was lack of centralization, but under the dogma of ‘post-bureaucracy’ this was ignored (discussed on p. 87 of the book). Fast-forward to the coronavirus crisis and what do we fine? That very quietly the government has taken back central control of procurement from the CCGs to deal with it.
Nor is it only in health care that we see the consequences of the ill-judged managerial reforms and budget cuts of the last decade or more. I wrote on this blog in October 2016 about the crisis that was already underway in prisons. No surprise, then, that coronavirus is sweeping through them now, and there are calls for the early release of at least low-risk offenders and prisoners on remand.
Beyond public service issues, the coronavirus crisis has laid bare the inequalities and insecurities associated with the new capitalism and its associated ‘precariat’ (discussed on p. 118-120 of my book). The supposedly self-employed ‘entrepreneurs’ and zero hours workers of Uberfied business models are by the far the most economically vulnerable to the lockdown of the economy. The gap between this precariat and the salariat (like me) who have continued security as they work from home is more obvious than ever. It falls to government, at least partially, to bear the costs of this – in effect bailing out the employers who have for years benefitted from this ‘flexible’ workforce. As with the financial crisis, what we see is a privatization of profits and a socialization of costs and risks.
Meanwhile, hundreds of thousands who had never expected to now turn to the welfare system and find that it is very far from the generous safety net they had imagined, let alone the scroungers’ paradise that the tabloid press had led them to believe (see also p.120 of book). This is not just a matter of a one-off crisis. Rather, it comes against the background of the middle-calls insecurity which has been underway for some time, and is intimately linked to the demise of middle management and the white-collar underclass that has characterized the new capitalist model (p.123 of book; see also this blog post from February 2015).
Intimately linked to precarious employment is the use of foodbanks (blog post from September 2016) and here, too, coronavirus has had an impact. On the one hand, they face mounting demand as people’s incomes dry up. On the other, staffing and donations are both impacted by the illness, and some foodbanks are having to close down just as they are most needed.
No doubt there are many more examples of how coronavirus is exposing underlying issues within the organization of public services, of work, and of society more generally. The key words are ‘exposing’ and ‘underlying’. In this post I have made frequent reference to what I wrote in my book or on this, accompanying, blog. The message is not meant to be a self-congratulatory ‘I told you so’. Rather, it is intended to show how so much of what is happening grows directly out of things we already knew, or which were already happening.
This is absolutely crucial for otherwise they would just be regarded as ‘crisis’ events and, as such, unusual or short-lived. This in turn would support the idea that once the crisis is over we can and should return to ‘business as usual’. To an extent, this is what happened after the financial crisis. Although many expected that it would lead to a wholesale re-evaluation of how – at the most generic level – we organize, that didn’t really happen. Instead, we saw what Colin Crouch aptly dubbed the strange non-death of neo-liberalism.
Perhaps this time things will be different. The neo-liberal or new capitalist model has been much more challenged by the coronavirus in that it has led to the mobilization of state resources in a way not seen since the Second World War. That ought, at least for a while, to put paid to the innumerable paeans to the superiority of the market for any and every political and economic question. It feels, at least at the moment, as if something quite fundamental has ruptured – although one should be wary in assuming that any such rupture will have predictable, let alone positive, effects. And even should they be positive, it is a tragedy that it will have taken the deaths of so many to demonstrate what was, in so many ways, already obvious.
Showing posts with label National Health Service. Show all posts
Showing posts with label National Health Service. Show all posts
Saturday, 11 April 2020
Thursday, 13 October 2016
Wells Fargo farrago
The
unfolding scandal
at US bank Wells Fargo, one of the most historic
organizations in the USA, is an interesting illustration of the perils of managerial
target-setting (see p. 30 of book). What seems to have happened is that sales
staff were under such pressure to meet sales targets that they simply invented
new bank and credit card accounts – and not just here and there: as many as two
million bogus accounts were created.
But this story is also interesting in showing that such perverse incentives are not just an arcane matter of organizational theory. The scandal led to the company having to pay out on a $185 million lawsuit, and the resignation this week of its Chairman and CEO, John Stumpf. And it shows the weakness of corporate whistle blower legislation.
Target setting lies at the heart of many organizational failures and scandals in recent years, whether that be the British NHS or mortgage lenders’ payment protection policies. There is little sign that the lessons of these have been learned. A huge scandal in waiting is the UK deregulation of pensions, which allows people to draw down and spend or invest their pension pot on the advice of salespeople working, of course, to sales targets. Watch this space for what will undoubtedly result in the coming years: pensioners in poverty because they have blown their savings under the paradoxical dogma of 'choice'.
Targets encapsulate the core issue of formal and substantive rationality in organizations (pp. 21-25) because they prioritise the former over the latter. Formal rationality valorises target setting as a means of control; substantive rationality valorises ethical conduct. The irony is that the former is seen as hard-headed business logic whilst the latter is seen as fluffy ethical stuff but, as Wells Fargo shows, that is a false logic. Had Wells Fargo been more substantively rational, it would not face its current problems.
But this story is also interesting in showing that such perverse incentives are not just an arcane matter of organizational theory. The scandal led to the company having to pay out on a $185 million lawsuit, and the resignation this week of its Chairman and CEO, John Stumpf. And it shows the weakness of corporate whistle blower legislation.
Target setting lies at the heart of many organizational failures and scandals in recent years, whether that be the British NHS or mortgage lenders’ payment protection policies. There is little sign that the lessons of these have been learned. A huge scandal in waiting is the UK deregulation of pensions, which allows people to draw down and spend or invest their pension pot on the advice of salespeople working, of course, to sales targets. Watch this space for what will undoubtedly result in the coming years: pensioners in poverty because they have blown their savings under the paradoxical dogma of 'choice'.
Targets encapsulate the core issue of formal and substantive rationality in organizations (pp. 21-25) because they prioritise the former over the latter. Formal rationality valorises target setting as a means of control; substantive rationality valorises ethical conduct. The irony is that the former is seen as hard-headed business logic whilst the latter is seen as fluffy ethical stuff but, as Wells Fargo shows, that is a false logic. Had Wells Fargo been more substantively rational, it would not face its current problems.
Saturday, 6 August 2016
Pulling teeth
Many thanks
to those readers of this blog who have written to me commiserating with the
dental problems I talked about in my last post. Treatment is still ongoing.
But it seems
that I am lucky in having a dentist who offered me the choice of root canal
treatment rather than an extraction. Because it
is reported today that many dentists now extract teeth unnecessarily as
they receive the same amount from the NHS as for more lengthy and expensive
treatments such as root canal surgery. NHS dentists are paid per ‘unit of
dental activity’ and both extraction and root canal surgery constitute three
units of dental activity. But since an extraction takes on average half the
time of root canal surgery, there is an incentive to extract.
Here we have
a very precise illustration of the perverse effects of targets, discussed on
p.33-34 of the book, and the nature of bureaucratic dysfunctionalism. Like so
much else that I write about in the book, the issue is not just one of the
technicalities of organizational systems. Rather, dentistry in the UK has
fallen apart for ideological reasons. Unlike other NHS services, it is no
longer free at the point of use and quite hefty charges have to be paid. Indeed
in many parts of the UK it is impossible
to get access to an NHS dentist at all.
The roots
(hah!) of this go back to the 2006 dental contract, the high watermark of New
Labour infatuation with quasi-market and managerial solutions to the provision
of public goods. In the intervening period there have been numerous complaints
and reports, but nothing much has changed so that in March 2016 the British
Dental Association (BDA) said:
“The 2006 dental contract is not
fit for purpose. It rewards dentists for hitting government targets for
treatment and repair, not for improving their patients’ oral health. It was
meant to improve access to NHS dentistry and put prevention at the heart of the
service, but it has failed on its own terms. It has deskilled and demoralized
the profession, and received criticism from patient groups, government, the
Health Select Committee and the Chief Dental Officers for England and Wales.”
It’s
important to understand that behind the bloodless formulation of being ‘not
fit for purpose’ lie real people and real suffering. The consequence is
self-dentistry, meaning, to be blunt, people extracting
their own teeth with pliers. This in one of the richest countries in the
world.
Saturday, 14 May 2016
Ageing badly
There is
plenty of public discussion of the complex issues involved in being a parent,
but far less about having parents. What I mean is the issues arising for people
in middle-age having to care for and cope with their ageing parents. Those
issues are made more complex by the way that families tend now to be dispersed
geographically and the much longer live spans that are now common. The
consequence is the necessity of engaging with the organization of care for the
elderly. In the UK, at least, that organization is woefully inadequate and in
crisis.
Longer live
expectancy is both a consequence of medical care and a cause of the need for
medical care. This in turn requires increased health expenditure, but in
2015 the UK health expenditure as a percentage of GDP was 8.5%: lower than
Greece, lower than most west European countries, and far lower than the US.
Against this, it has to be recognized that the UK system is far more efficient
than others in translating expenditure into health outcomes. Maybe more
important, though, is that increases in UK health expenditure don’t
match increased costs (healthcare cost inflation is much higher than
general price inflation) and increased demand (driven primarily by ageing).
But
healthcare is only one part, and not necessarily the most important part, of
the organization of ageing. Most health expenditure arises in the last two
years of life; whether that life ends at 70 or 90. No, the real issue is the
organization of care, and this is in complete
crisis. Whereas it used to be provided mainly by local authorities, now
there is a hybrid system of private care homes part-funded by local
authorities. Budget cutbacks mean that the part-funding
is increasingly inadequate; whilst the crazy financial engineering of some private
home owners like the collapsed
Southern Cross (discussed on p.115 of the book) exacerbates the problem.
The two
aspects of health care and care homes are closely related. Both emergency and
routine care departments of hospitals can’t
discharge elderly patients because there is nowhere for them to go,
especially if
they are ‘unprofitable’ from a care home perspective. On the other hand, as
a
report this week highlights, in other cases the elderly are being discharged
back to their own homes when they are incapable of coping, with horrific
consequences.
All of this
is absolutely to do with failures in the way that we organize. The privatized, often
private equity firm-owned care home system is simply absurd, and passes on its
inefficiencies to the public sector NHS. But beyond that is the obvious
absurdity of dividing health and social care at all. There has been much talk
of overcoming it, and some
areas in England have made progress in doing so but overall the separation
remains stubbornly in place.
As is often –
perhaps always – the case, the issues relate to both organizations in the
institutional sense (the structures of, in this case, health and social care)
and to ideational organization (the construction of ‘health’ and ‘care’ as
categories). Underlying the latter is perhaps also the more profound division
of the public and private realms, so that health care is something that happens
in the public domain of the hospital ward and social care something that
happens in the private domain of the home (even if the home is an institutional
‘care home’). This in turn means that much suffering remains hidden (‘at home’)
and experienced by both the elderly and their families as a ‘private’ problem,
and possibly a stigma.
The
psychology of this is undoubtedly very complex, since the relations between
(adult, ageing) children and (aged) parents has the capacity to engender guilt,
frustration, anger, fear and much else besides. Psychology has been much
concerned with the relationships of children and parents in infancy, but
perhaps much less so (at least, that’s my impression) with those in adulthood.
The dynamics of the latter are surely taking new forms as extended old age and
associated dependency become the norm rather than the exception.
In 1911 in
the UK life expectancy was 51 years; by 2013 it was 81 years. In 1911 there
were 107 people in Britain aged 100 or over; in 2013 there were 13,780. A
similar pattern can be found across the developed world. Organizationally, and
emotionally, we have not really caught up with these profound demographic
changes.
Friday, 30 October 2015
Legitimate questions
The concept
of legitimacy is central to organizations in many ways, most obviously in terms
of who has the right to tell others what to do, and what kinds of things this
applies to. That is one reason why many books about organization studies –
including mine – begin by talking about Max Weber’s account of authority (in
the meaning of legitimate power).
I was
thinking about this in relation to the current political row in the UK about
the House of Lords’ rejection of a House of Commons policy to cut tax credits for people in work. I won’t discuss the tax credits issue itself - important as
it is – it is the issue of legitimacy that I want to look at. Britain, famously
and unusually, has an ‘unwritten constitution’, and so relies on custom and
precedent to determine what is legitimate. In this way, it could be seen as a
system based partly on what Weber called ‘traditional authority’ in contrast to
the rational-legal authority of written constitutions.
Since the
House of Commons is elected on the basis of, certainly, a system of rules and
to this extent rational-legal, and the House of Lords is an unelected body the
government have been keen to say that the Lords’ action was illegitimate. More
precisely, the argument is that it is illegitimate because it violates the ‘convention’
that the Lords will not block financial legislation or legislation deriving from
an elected government’s manifesto.
But
convention is a rather slippery terrain. As regards tax credits, what was
blocked by the Lords was not, technically, financial legislation but, rather, a
‘statutory instrument’. It’s an arcane point that needn’t detain us except to
the extent that it shows the imprecision of ‘tradition’ as a legitimating
principle. On the other side of the coin, the House of Commons, whilst
certainly elected, has a government majority on the basis that the ruling Conservative Party achieved 36.9% of the votes cast on a turnout of 66.1% of the electorate.
In other words, 24.4% of the electorate voted for them.
Moreover,
although the Conservative Party manifesto promised extensive cuts to the
welfare budget, it did not specify that these would include cuts to the tax
credits of working people. It is at least questionable whether they would have
been elected had they done so. My sense is that what the electorate thought was
meant by welfare cuts was cuts to benefits of people out of work. One might say
so much the worse for them, but even so the point is that democratic consent to
this policy looks rather threadbare.
The
imprecision of party manifestos is by no means new. For example, at the 2010
election the Conservative manifesto promised that there would be no top-down re-organization of the NHS. In government (with Liberal Democrat support) there
was massive and controversial re-organization. The disjuncture became an
argument about what ‘top-down’ meant. At one time these manifestos consisted of
quite precise lists of policies. Now, they tend to be much vaguer. And this in
turn links with a far more ‘presidential’ approach to UK politics in which the
persona of the leader is the key issue, even though the ‘constitutional
convention’ is that a House of Commons is elected constituency by constituency
and the leader is the person who can command a majority. Thus a key aspect of the
last election was which of David Cameron or Ed Miliband was the most ‘prime ministerial’. So, here, what is at stake is what Weber called ‘charismatic
authority’.
This complex
mish-mash of rational-legal, traditional and charismatic authority makes for
plenty of political spectacle and debate. But I wonder if it does not also show
the limitations of Weber’s ideal-types of authority? Isn’t it actually rather
common for, say, a CEO to draw selectively and eclectically on the different
types*? And more challengingly, isn’t the idea that there is a distinction of
authority and power a rather dubious one? After all, whatever is decided about
tax credits, those affected by or hostile to the changes will ultimately be
forced to accept them.
On a more
personal note, this week I was awarded the title Fellow of the Academy of Social Sciences (FAcSS). This, too, is about legitimate authority – the Academy’s
legitimacy to award the title, the legitimacy it bestows on me. But of course I
am just shoehorning this in to make it fit with the rest of the post. The truth
is that I am rather pleased and want to boast about it.
*Something
like this has always been the critique of ideal-type reasoning and the defence,
of course, is that these are
ideal-types, for conceptual clarification rather than empirical claims. I
suppose that my point is that in political debates like this one an ideal-type is treated, at least by implication, as an empirical claim.
Thursday, 1 October 2015
Intended consequences
In
the book, I make much use of the concept of ‘unintended consequences’ – the way
that, in particular, rational-legal rules give rise to effects that were not
only different to those intended but run directly counter to what was intended.
My last post on the VW emissions scandal provided a current example.
But
sometimes the situation is more complex, and I return here to the case of
regulations around smoking, about which I have written in another post on this
blog, and, with Jo Brewis, also written an academic paper (Brewis & Grey,2008). The latest development is that today a law has come in to force banning smoking in cars when a person less than 18 years old is present in the car. It’s
by no means an objectionable law, in and of itself, because who would want to
claim that smoking in a car with children is in any way a good thing?
What
is interesting about this law, though, is that it is manifestly doomed to
failure. Police representatives have already said that it is unenforceable,
partly due to lack of resources but also because of detection problems. For
example, electronic cigarettes are not included in the legislation so a police
patrol would not easily be able to tell whether an offence was being committed,
nor is it easy to know the age of passengers from a patrol car. Moreover, the
legislation allows 17 year olds to smoke in cars if the passengers are 18,
allows smoking in convertibles with the hood down, and allows smoking in
caravans and motorhomes, even if children are present, so long as the vehicle
are not at that point moving.
We
might, then, assume that the intended consequence is to stop smoking in cars
with children and that the unintended consequence is it not working. But in
fact the situation is more complex. The long-term aim of anti-smoking activists
is the eradication of all smoking, but they approach this goal stealthily
because smoking is such a strongly culturally embedded practice. From that
perspective, the failure of this latest legislation will be desirable, because
when it fails it will justify a new law banning all smoking in all vehicles in
all circumstances.
Social
science research is sometimes criticised for lacking the predictive power of
natural science, so here I will make a prediction. Within, say, five years (and
I would expect less rather than more) a total smoking ban in cars will be in
force. And as soon as it is, or even, possibly, before there will be lobbying
for a ban on smoking in houses where children are present. Once again few will
object, because no one could really mount a case that it would be good to allow
it. So a law will follow, which will of course be even more unenforceable than
that against smoking in cars with children. From which will ‘logically’ follow
that all smoking by anyone in any house will be banned.
By
that point, the situation as regards public spaces (e.g. bars) and private
spaces (e.g. homes) will be identical: smoking in both is banned. So what
happens then? Well, look at what is happening around the regulations on public
spaces. At first, it was just indoors. Now, it is increasingly in parks and on
beaches which are public spaces but outdoors, including outside pub doorways.
The rationale for this is not that others might inhale the fumes, but that
those (especially children) seeing it might think that smoking was ‘normal’.
So, once there is a ban on smoking inside homes, it will get extended to smoking
outside home, for example in gardens. In other words, as each new rule ‘fails’,
that failure provides the rationale for a new rule. It is in this sense that
failure is an intended consequence of
regulation since it paves the way for successfully extending regulation.
With
smoking now very much a minority activity in the UK and many other countries,
few will shed a tear about any of this (and it’s not my intention that anyone
should: I just want to provide an interesting illustration of a particular
phenomenon around unintended consequences). But it’s worth reflecting that with
the campaign to reduce smoking now being acknowledged as the gold-standard of
public health campaigns, the same tactics are being applied to another deeply
culturally embedded practice (as smoking was a generation ago), namely alcohol
consumption.
As
with smoking, the initial restrictions have been around advertising. Then
(rather like the 1970s campaign that smokers should choose cigarettes with
filters and leave long stubs) there has been the definition of safe drinking
limits, which turn out to have been ‘plucked out of air’. Now, as happened with
smoking, some campaigners say that there is no safe limit for alcohol, and
although that is not mainstream in the way that it is for smoking it is
accepted to be true for pregnant women. Meanwhile, just as there used to be a differentiation
of ‘light’ or ‘social’ smokers from the hardcore we have a similar
differentiation of social and ‘binge’ drinkers, with a binge drinker being someone drinking more than 3 pints of beer. The key move in anti-smoking discourse was
to establish the notion of passive or secondary smoking, and the same shift has been mooted by former UK Chief Medical Officer Sir Liam Donaldson, who is also
responsible for the Orwellian declaration of aiming for the complete
denormalization of smoking.
So
here’s another prediction – as smoking fades away, restrictions on alcohol will
increase along with restrictions on sugar and ever more demonization of
obesity. Each restriction will give rise to failures which far from being unintended
will have been designed to fail, in
order to justify further restrictions. But the law of unintended consequences
will still hold, and indeed it is already very clear that this is so. Because
the more that unhealthy practices, such as smoking, drinking and over-eating
are reduced, the more we see the degradations of dementia, of old age blighted
by complex and intractable multiple illnesses, of obscure cancers that were
rarely known before.
Moreover, since taxes on smoking are, massively, a net contributor to the NHS (and the same is true for alcohol) the less we smoke the
more difficult it will be to fund the healthcare for the longer lives we will
indubitably – for, of course, the anti-smoking campaigners are quite right to
point to its dangers – be living. But that, too, is not really an example of an unintended consequence since, as Jo Brewis and I argued in our article, the real motivation of the anti-smoking movement is not public health, but the imposition of a morality about smoking that long precedes, and proceeds quite independently of, any scientific or medical rationality. They simply reproduce, in modern language, King James I's (1604) Counterblaste to Tobacco:
Have
you not reason then to bee ashamed, and to forbeare this filthie noveltie, so
basely grounded, so foolishly received and so grossely mistaken in the right
use thereof? In your abuse thereof sinning against God, harming your selves
both in persons and goods, and raking also thereby the markes and notes of
vanitie upon you: by the custome thereof making your selves to be wondered at
by all forraine civil Nations, and by all strangers that come among you, to be
scorned and contemned. A custome lothsome to the eye, hatefull to the Nose,
harmefull to the braine, dangerous to the Lungs, and in the blacke stinking
fume thereof, neerest resembling the horrible Stigian smoke of the pit that is
bottomelesse.
Friday, 17 July 2015
Right diagnosis, wrong prescription
A
long-delayed report into the organization of the British National Health
Service (NHS) has belatedly been published this week, with remarkably little
media coverage. It was prepared by Stuart Rose, the former boss of retailer Marks
& Spencer, and we might wonder to what extent his expertise is relevant to
the NHS. Nevertheless, he makes a good fist of explaining how constant and
contradictory changes have led to ‘change fatigue’; how targets have had a
dysfunctional effect; and that the recent marketization of the NHS in particular
has led to a virtually unmanageable situation.
So far, so
good, and very much in line with what I have written recently on this blog
about unhealthy management and healthy bureaucracy in the NHS. Unfortunately,
Rose goes on to wheel out the tired and predictable nostrum that the solution
is better leadership and leadership training. We’ve been round this loop
endlessly in, especially, the public sector: first it’s better management that’s
needed, then better structures, then culture change, then better leadership.
Leadership, especially, currently takes on an almost magical character as the
universal panacea for what ails organizations. There's an extraordinary impoverishment in the managerial imagination that keeps its proponents going round a hermetically sealed loop of systems (management, organizational structures) and values (leadership, organizational culture).
I don’t actually
disagree that leadership (and management, and structure, and culture) matter
both in organizations in general and in the NHS. But it is woefully inadequate
to think that these things can make very much difference in the face of
overwhelming resource deficiencies. As I’ve pointed out before on this blog,
health costs are spiralling because of ageing populations, scientific advances
and healthcare cost inflation that exceeds general price inflation. UK health expenditure
per head is US$3405 or 15 in the world (OECD, 2011 figures), and this does not
include the allied issue of care spending for, in particular the elderly.
Now, for
sure, expenditure isn’t the whole story because the UK system of socialized
health is more efficient than any other. Moreover, I’m very well aware that the
situation in the UK is enormously privileged compared with most of the rest of
the world. Still, there is a basic arithmetic here. How much difference can
leadership make when compared with resources? Suppose, modestly, that it was
equivalent to a 1% increase of per head expenditure. Then, the UK would remain
at 15 in the league table. Suppose, more extravagantly, it was the equivalent
of 10% of per head expenditure. Then the UK would rise to 14 in the list.
Suppose, ludicrously surely, it was equivalent to a 20% increase in per head
expenditure. Then, by a whisker, it would be 11 in the list. In fact, even if
leadership had the capacity to be equivalent to a 100% increase, a doubling, in
per head expenditure then the UK would still only be second in the global list.
But consider this: no study has definitively shown that leadership makes any
difference to organizational performance at all.
Saturday, 13 June 2015
Healthy bureaucracy
This post
relates in some ways to my previous one about NHS management, but is both more
specific and yet with a wider import. In the current issue of the satirical magazine
Private Eye the Medicine Balls column
discusses one of the consequences of recent NHS reforms (the column is not
available on the Private Eye website, but appears on p.17 of Issue 1394). These
reforms, like most or even all public sector reforms, purports to reduce
bureaucracy. Yet the column describes how the new rules mean that whereas a
doctor’s surgery seeking to run community health services from its premises
used to have simply to make a contract with the local health trust, now it
involves a negotiation between four different bodies with multiple convoluted
procedures.
This is a
story that could be repeated endlessly across both private and public sector
organizations. Bureaucracy is the enemy above all others (see p.81 of the book)
and yet in the name of defeating it ever-more complicated bureaucracies are
developed. What sense might we make of this? I think that one answer is that ‘bureaucracy’
has ceased to mean anything very precise (and certainly nothing like Max Weber’s
meaning), but instead has become a catch all terms for ‘things we don’t like in
organizations’. It takes a brave person to argue, as Paul du Gay does in a book
I refer to several times in my book, in praise of bureaucracy (by which he does
indeed mean Weberian bureaucracy), and for a practicing manager, civil servant
or politician it would be simply unthinkable.
The irony of
this, though, is that it is not just thinkable but necessary for managers,
civil servants and politicians to devise systems which conform not to Weberian
bureaucracy but to precisely its everyday sense of inefficient red-tape. We
thus have the worst of all worlds: a crusade against the praiseworthy features
of bureaucracy (accountability, impartiality, clarity) in the name of an
anti-bureaucracy that embodies the most deleterious features of bureaucracy
(complexity, sclerosis, proceduralism).
There are so
many examples that it is difficult to know where to start in naming them but
they range from the impossibility of switching internet service provider without a ‘key’ from your current provider to allow it, through to the chaos caused in courts because of ‘efficiency savings’ to interpreting services. But
to take one recent example, last week a new system for driving licences was
introduced in the UK. According to the government minister responsible this would “reduce unnecessary red tape” (aka bureaucracy). The result? Chaos.
Of course
any one example can be dismissed as both minor and specific. But the cumulative
effect is general and major. A huge array of transactions, both economic and
civic, are becoming all but impossible. Weber would have found this completely
understandable because it is emblematic of some of the problems to which
bureaucracy was as a solution. He might also have observed, had he been alive,
that bureaucracy would be the best way of addressing the FIFA corruption scandal. Or, at a more local level, a way of controlling free-wheeling head teachers, freed from bureaucracy to do their own thing.
The
association of bureaucracy with ‘something bad’ goes back many decades but it’s
a misnomer. It’s difficult to imagine an effective campaign for bureaucracy.
Yet a good dose of bureaucracy, in its healthy sense, would make all our lives
better.
Reference
Du Gay, P. (2000). In Praise of Bureaucracy. Weber, Organization and Ethics. London: Sage.
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