The Planning Fetish

By Gerrit Van Wyk.

” ‘n Boer maak ‘n plan”.

For many generations, most of my ancestors were farmers, with many farming in remote areas far from cities and supplies. From this experience, a can-do culture emerged and the saying in their language: “’n boer maak ‘n plan”, which, translated, means a farmer makes a plan. When things go wrong, or breaks, you must fix it with whatever resources are available, which, to them, often was very little. You had to be pragmatic and creative to survive, and that wisdom is still relevant in our modern world.

A fetish is something we believe has magical power for protecting us, or something we devote ourselves to, and a lot of planning, and particularly strategic planning, fits that bill. We think our plans, no matter how deficient, will magically protect us, and a lot of time in organizations is therefore spent on planning.

A plan can be a goal, or the activity for achieving that goal. Russell Ackoff said a lot of planning is like a rain dance, its more about dancing than the rain, or the planning game socially and psychologically matters more than whether we actually come up with a plan that may work. No wonder evidence shows only 5-15% of plans are implemented in some way, or as planned.

In the management world, you are taught if you find yourself in a problem situation, you create a goal that will solve the problem, find different ways for closing the gap, analyze and rank them, choose the best one, and implement it. Senior managers make plans, middle managers give the orders, and employees and workers implement it, and voila, everything will be good. Except, most of the time, it isn’t, and then we blame the middle managers and employees for messing things up, and start the whole process all over again.

A lot of the planning is strategic, which comes from the military, and means creating conditions that will give you an advantage over some sort of enemy out to harm the industry, business or company. As it turns out, managers and planners are not very good at outwitting imaginary enemies. It’s a known fact that famous battles don’t win wars; most battles are won not because they were planned well, but despite the plans. The same applies to managerial strategic planning.

Ralph Stacey, following the modern pragmatism of Hans Joas, talks about ideology as a combination of what we value and our rules and standards, and when we expect everyone to share the same values and standards, it becomes cult-like. One could say planning is an ideology and often cult-like, particularly in healthcare. It is a set of management values, rules and standards which everyone in the organization must share, otherwise you are not a team player.

An interesting subcategory of planning, which Bent Flyvbjerg studied extensively, is managing projects. His database shows only 8.5% of projects are completed on cost and on time, and only 0.5% on cost, on time, and show benefits. He argues what drives success or failure is universal. Planning and implementation is complex, which means small changes or events have big consequences (a butterfly effect), therefore it’s important to spend time thinking through the plan and outcome properly before rushing in to implement it. Most projects don’t go wrong, they start wrong, and the problem in North America is we venerate doing, not thinking.

Because of our action orientation, we rush to commit, are overly optimistic, and underestimate what’s involved. It makes managers feel more competent implementing plans than making them. Hence, most projects start with pre-packaged answers, not questions, which is a mistake; in practice the project is not the goal, it is how a goal is achieved.

Contrary to management theory, most plans or problems are not clear to begin with, more often than not they are fuzzy. To get around that requires a cycle of experimenting and learning, which should be repeated until the goal becomes clearer and kinks are ironed out. Only then should one implement, which means it is likely once that happens, it can be done quickly, thereby avoiding unplanned events that can derail it. In reality, many plans are ambitious and driven by money and self-interest, ignoring the practical wisdom of experience, which increases the risk of failure. It is better to involve people with experience, use tried and tested technology, and what we already learned and know, rather than try reinventing the wheel, or engage in vanity projects.

Secondly, there is a strong human social component to successful implementation. Well functioning teams are required, which means either using existing groups with strong interrelationships, or creating them by putting the right people in the room. But you don’t only need strong teams, you must also provide them with whatever resources they require, and engage with them in ongoing conversation and dialogue to surface and use their wisdom as the project proceeds, which requires a psychologically safe space. This is very much the opposite of traditional change management approaches.

Finally, Flyvbjerg argues the risk of failure is reduced by using the complexity principle of self-similarity to build projects. It means building more complex outcomes by using simple similar basic blocks proven in practice, much like building with Lego. It makes it easy to scale up or down, and builds experience of the project and amongst participants.

Although project planning is about building inanimate things, Flybjerg’s suggestions show an intriguing similarity to Strümpfer’s incubated learning, which was specifically designed for use in human social systems, and can be expected to succeed 85% the time, which is the exact opposite of current approaches.

What this tells me, based on solid evidence, is planning and implementing based on principles of complexity and specifically social complexity is more likely to succeed than the rain dancing we engage in at present.

Until now, in healthcare, we have been following a planning fetish, ideology, and cult, and danced until we fall down from exhaustion without producing any rain.

I’m convinced incubated learning has a chance of changing healthcare for the better, but, as both Flyvbjerg and Strümpfer point out, many plans fail because of politics and self-interest, and if that dominates, it’s better to walk away, which, sadly, is the default in healthcare. It means what we need and works never gets an opportunity to make things better. There is a proven cure available, but we prefer living with the disease.

My ancestors could fix things with little resources and money, and the same applies to building through self-similarity or incubated learning, which means healthcare is fixable, and it doesn’t have to cost a lot. But it requires that we put our egos, self-interest, and political games aside, and that is the difficult part.