The Complexity Of Organizations

By Gerrit Van Wyk.

Look who’s back.

Many believe the training, organization, and staff structure of the German army at the beginning of World War 2 was second to none, as its early successes showed. The problem was a corporal with a funny brush mustache thought he knew everything and starting micromanaging strategy and the generals. When the Allies invaded Normandy, the little dictator was asleep and everyone was too afraid to wake him with the bad news, until it was too late.

Taylor thought manufacturing and organizations can be managed scientifically. That requires trained leaders and managers, and to train them, rich benefactors from industry sponsored spanking new business schools and departments in universities named after them. To be credible, the newly minted business “science” had to be “scientific”. which meant doing research, starting business journals, tenure track, etc., and sending armies of newly minted students armed with this clockwork knowledge out to manage things.

Even today, the basic format of that teaching remains the same. They taught me in business school organizations consist of blocks; human resources (humans are resources, not humans) that must be managed, production, sales and marketing, finance, and information technology. Managers manage and leaders spend their time planning strategy for the future. These functions are Lego blocks and if you put them together you’ve built an organization.

In 2017 the province I worked in was reorganized into one health region to make it “more efficient”, and reduce costs. When you look at their website, like other organizations, they have an organogram following the Lego model. Everything fits neatly into little bricks cascading down, or up, depending on where you stand, along reporting chains, like an army. Blocks are autonomous, work separately, information flows up flawlessly, allowing senior staff at the top to plan, lead, organize, communicate down, and control in a far away big city.

Common sense says healthcare is a complex social activity. It means people exchange information, respond to that, often unpredictably, adapt to it, and learn, which means something constantly on the move and in flux. At business school we briefly toyed with the idea organizations may work like systems but smartly discarded that dangerous idea. If they are like systems, you can connect how the blocks interact together and exchange information into a spaghetti diagram ending up with something as below.

Now the corporal generals at the top have a problem; nothing fits in boxes anymore, there’s no beginning or end, if you change one thing other things change as well, which makes things less predictable, and the outcome of implementing plans becomes uncertain. In this model humans are not resources to be managed, they are purposeful and respond to each other in complex ways. And yet, those at the top are still taught an obsolete model of organization which makes them believe with an Ivy League degree they can manage and control the complexity.

Clearly, we need to admit the obvious; health care is a social human activity and as Peter Drucker said, complex along three dimensions, biological, technological, and above all socially. It means being a leader or manager does not mean being on top of a tree or pyramid, as the diagram shows, you are very much part of it, and your actions have consequences, often not as intended. It means you can’t plan for people, as we were taught for our fancy degrees, you must plan with them. It means you can’t control, because there are too many balls in play. What it doesn’t mean is, giving up, and walking away, or just shrugging and continuing as before.

By all accounts, health care is in trouble and to stand any chance of saving it requires a whole different mindset. There are a handful of people trained for this and many more willing to follow, but it means the little corporals must wake up and have a change of heart, otherwise we’ll lose this war.