Friday, February 8, 2019

Fixing the Organizational Chart - Won’t Fix Health Care

Many many years ago, when I went to university, I began taking business courses as I felt that was a practical way to advance my career.  I recall a sessional instructor that we had.  I always enjoyed sessional instructors because they always seemed to try harder - they weren’t the stodgy tenured types that only seemed to put me to sleep. 

I distinctly remember "Intro to Management."  In addition to some other topics, this course taught us the basics of organizations and the many ways they could be constructed.  To this day, I still remember our instructor pounding basic concepts into our brains.  I recall her saying that if she were to wake us up in the middle of the night - her expectation was that if we were just coming out of a dead sleep she would ask us what the four functions of management were and we should be able to answer that question instinctively and without thinking.  Her teaching must have done something for me because to this day I can still list them off…Planning - Leading - Organizing - Controlling.  Of course this answer has been updated as we don’t use the term “controlling” anymore and now we use the much more politically correct term “directing.”

In addition to these basic facts we looked at different types of organizations and how they are constructed.  We looked at centralized vs decentralized organizations.  Organizations built around product types or geography.  What’s been fun for me is to reflect on the many organizations I have worked for and think about how they were/are constructed and what organizational structures work well and which ones don’t.  The conclusion I keep coming to is that the structure of the organization can be an impediment to an organization’s success but if there are large problems - changing the organization structure will not solve fundamental business problems. Structure is important but it is not fundamental.

Take a quick look at some of the most epic business fails in recent history.  Blockbuster Video, Eastman Kodak, or Sears.  Would a different organization structure have made any difference to these companies? No. Perhaps some different people within the organization may have helped but the actual structure itself would have had little difference on their eventual downfall.  Poor business decisions or a failure to adapt to a changing market are the reasons businesses fail.  Analysts would call these the "business fundamentals."  I may be totally wrong here but I don’t think Sears would have been saved by moving to a matrix organizational structure.

This is why I find it somewhat sophomoric that within our Canadian Healthcare system we tout organizational change as a catalyst to solve our profound health care woes.  Let me be clear.  Changing the structure of an organization can help facilitate changes but it is NOT a root cause issue.  If you are providing mediocre service and you change bosses - how does that actually facilitate an improvement in service?  It doesn’t. Now...if that new boss has the authority to change how you do your work...that is very different.  So just like a new boss - a new organization structure on its own will not solve any problems.  It is what they do, or what they are allowed to do that really matters.

We are going through changes in our health care organization in Manitoba and now we are getting a lot of media attention on some of the proposed changes in Ontario.  Saskatchewan has centralized their services and so has Alberta.  It is happening all over the country.  Will it make some modest improvement - possibly - I hope so.  Will it solve the BIG underlying health care problems?  Not a chance.

The underlying problem in Canadian Health Care is that our demand for health care services by our population far outweighs the availability of those services.  The result is wait times, over extended care providers, not enough physical capacity and the most disturbing result is harm to patients.
What is even more frustrating to me is that many of the big issues in our health care system are well known.  Both the Romanow Report and the Naylor Report call for fundamental changes in the Canada Health Act.  Suggesting a change at this level is not controversial but what becomes very controversial is spelling out specifically what might be proposed to replace it.  For a government this could be political suicide.

We need to look at some of the foundational issues that plague our system.  However, the issue is that we cannot have an honest discussion in this country about health care policy without the discussion devolving into an idealogical battle that get us absolutely nowhere.  Terms like “privatization” and “single payer” are tossed around with little understanding of what those terms actually mean.  Can a single payer system incorporate many free market components?  Yes…but don’t dare suggest it.

I think what I find most offensive is that we have a health care system that is effectively run by political interests.  Politicians are very good on capitalizing on sub-par health care statistics to vilify the sitting government and get themselves elected.  Then once in office they stare at each other with blank looks as they have no idea what to do to solve the problem.  In many cases the solutions would require significant change which would bring howls from the opposition forces.  It is more politically expedient to nibble at the edges of the health care system than face the vitriol if substantive change were to be proposed.  So what do we get from every new government that gets elected?  A change in the structure of the organization.  The health care equivalent of re-arranging the deck chairs on the Titanic.

Sorry folks…the ship is still going down.

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