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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