Unless you have been living in a cave for the last 5 years, you have heard lots of talk about Web 2.0 and Health 2.0, the 21st Century versions of the internet and the health care system. Changes in technology, social structures, medical science and culture has led to huge changes. Is the same thing happening in the fields of management and leadership? Is there a management (or leadership) 2.0 just over the horizon? If so, what would it look like in health care?
Current mainstream management - let’s call it Management 1.0 - grew out of a need to maximize efficiency and productivity by minimizing variance from a central developed and administered manufacturing plan. In the 19th Century setting where management science and all our current management principles evolved - manufacturing of multiple identical iterations of a product using unskilled labor and fungible contingent raw materials - Management 1.0 provided the adaptive edge that made the US an industrial powerhouse and world leader by the middle of the 20th Century.
Time passes, and that era is fast vanishing. We have moved from an economy and culture based on manufacturing to one based on service industries and information. Unfortunately, the old models of institutional organization and management persist. The song is over, but the melody lingers on. The result: systems that empower a narrow and usually homogeneous oligarchy at the top, that devalue unorthodox concepts or innovative approaches, that fear and fight transparency, that channel communication, that revere protocol and prescribed process and inhibit initiative, and that limit the ability to initiate change or experiment. Despite new-age management fads that spread virally at retreats and leadership conferences, and widespread lip service to collaborative models and lots of buzz words, the basic systems remain rooted in hierarchical and centralized command and control.
For health care, this is a prescription for disaster. Health care is not a product like an automobile or dishwasher, where the goal is perfect replication of design. In both medical research and health care care delivery, each problem and each patient is unique, and while each process must be based on universal and validated principles, it must also be individually crafted and constantly adjusted in real time for its individual setting. In manufacturing, consistency and intolerance of variation are foundation of quality. In health care they guarantee mediocrity.
I do not mean to imply that current management and leadership is unchanged from its glory days of the mid 20th Century. Change has occurred - but not deep change. The strict centralized command and control with its paternalistic culture and study of the past to predict the future peaked by the mid 20th Century and then evolved into the era of the MBA characterized by incorporation of social changes like diversity and technology. The last 15 years have seen a seismic shift in both technology and culture, with vanishing transaction costs for communication and information storage and dispersal, democratization and amateurization of media, the development of a multiplicity of network paradigms, and the emergence of self-organizing communities. Not surprisingly, this is having an impact on the structure and function of organizations and their management with a movement toward complex and constantly adapting systems based on freely available information, open and unfettered communication, self-regulation and peer management, and vision driven strategies.
What does an organization using Management 2.0 look like? It has the following characteristics:
- It is built on a culture of trust among peers rather than a system of regulation and compliance, enforced by authority.
- Communication is unfettered and transparent, with engagement coming from the matrix of many:many dialogues, rather than broadcast (one:many), unidirectional and aimed at persuasion
- Information and wisdom are seen as created by, belonging to, and available to the entire community rather than proprietary items owned and controled by individuals or small subgroups.
- The concept of a hierarchical organizational structure is replaced by a concept of a self organizing and self regulating network, where management is seen as connectors rather than directors,
- Central planning based on a homogeneous and oligarchic group of experts is replaced by community collaboration based on internalization of the central purpose and values of the organization
- The members of the community (patients, clinicians, support, IT and management) are equal members of a distributed structural ring without a pyramid
In pictorial form, it looks something like this:
What does your organization look like? Mine, unfortunately, is responding to these changes and the opportunities they represent more with fear and avoidance than with interest or endorsement.