Management

For content related to management

Building boats and EHRs

Imagine that you want a boat. You tell someone to build or buy you a boat, and tell them to send you a bill. What would you get? A kayak? A windsurfer? A boat for waterskiing? A sailboat. A party boat? A cruise ship? A submarine? A battleship or destroyer? You probably would not get what you want. Very likely you would end up with something expensive - that you cannot use.

Before you build or buy a boat, you need a defined goal and a process:

Why bother

A professional colleague and I were discussing (bemoaning) how hard it is to do quality primary care. She asked why I bothered to keep pushing for change in the face of so much institutional resistance and evidence that it was pointless. I told her, what we put up with is what we end up with.

In return, I asked her why she didn't push back and demand change if she is so unhappy about the way things are?  

Her response: "Well, I watch you, and I can see that it is pointless."


 

Two kinds of leadership

Leadership can focus on making sure everyone does their job. Or leadership can focus on making it easy for everyone to do their job. The former is more common, the latter is more effective.


 

The delusional pursuit of metrics

Two points:

  1. Measuring something is not the same as improving it. 
  2. Improving something requires thinking of quality as a process rather than a product.

Before we think about how these two principles apply to medicine, let’s consider two approaches to coaching basketball: one using incentives tied to outcome metrics, and one using interventions designed to identify and address process problems.

Let there be bureacracy

“And God created the organization and gave it dominion over man.“

(attributed to Peter Townsend)


 

EBM and P4P: Uniforms don't make the man

There is a push afoot to use evidence based medicine (EBM) to generate standards of care and then use pay-for-performance  (P4P) to Nudge people towards better behavior.

Honor the heretics

In an organization – as in society – there is an important distinction between faith and religion. 

Faith is belief in the organization’s mission, supported and embodied in its values and long term goals. In a successful organization, faith is a common good, co-owned and held by the entire community.  Leadership doesn’t own or control faith, but functions as steward and guide, helping the community stay connected with (and by) their shared faith.

In praise of the PITA

You know who I mean. We've all had to work with (or around) the guy everyone calls the pain in the ass.

He is not the person you would choose to make the decision, but he is a person you definitely want in the room when the options are being explored.

Meetings as a collaboration deterrent

Meetings are an excellent tool for top-down hierarchies to manage and control information and decision making, but are inherently inimical to broad participation or collaborative processes.  Here are eight specific ways in which meetings, when used alone,  represent a barrier to collaboration rather than a collaborative tool…

Meetings: good, bad, and sometimes ugly...

A meeting is an unnecessary gathering of the unwilling, led by the unknowing, doing the impossible for the ungrateful. (Slogan from a popular poster during the 1960s.) 

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