Bureaucracy Is Keeping Health Care from Getting Better

by | October 20, 2017 11:26 am



In a recent HBR article, Gary Hamel and Michele Zanini detail the toll that growing bureaucracy is taking across industries. Many of those working in the consolidating health care industry will immediately validate several of the authors’ key findings, including:

— Bureaucracy is growing, not shrinking.

— Bureaucracy is destroying value in innumerable ways, including slowing problem solving, discouraging innovation, and diverting huge amounts of time into politicking and “working the system.”

— CEOs are substantially less likely than front-line staff to see bureaucratic barriers in their organizations.

Hamel and Zanini declare that there is “no map to disassembling bureaucracy.” I beg to differ.

Great organizations across industries fight bureaucracy by explicitly structuring their leadership systems to connect everyone in the organization to the issues that the front line is encountering every day. They carefully define the roles of each layer of leadership to include supporting the rapid solving of front-line problems and developing those under them to do the same.

Two cornerstones of this approach provide clear examples of how to fight bureaucratic bloat: lean daily management systems and a real-time problem-solving approach to eliminating workplace injuries.

Lean daily management systems were pioneered by Toyota, Honda and other manufacturers. As John Toussaint, the CEO of Catalysis and the former CEO of ThedaCare, a health system in Wisconsin, explains, such systems, when designed and operated effectively, ensure that every leader has explicit work that they must do every day to help understand front-line problems and improvement opportunities. Lean daily management makes top-level goals and strategies very clear and present for everyone in the organization and ensures that leaders’ efforts help, rather than hinder, the front-line work necessary to meet those goals.

Real-time safety learning provides a complementary antidote to bureaucratic bloat. At Alcoa, DuPont and other world leaders in safety, any injury is reported all the way up to the CEO, investigations and solutions are reported within 48 hours and all of this information is shared with everyone in the company every day.

For leaders, this provides a daily, concrete, values-centered indication of whether the organization is effectively learning and solving front-line problems, or whether those signals  are being blocked and why. It forces the bureaucracy to support, rather than impede, the rapid breaking of barriers, problem solving and front-line learning and empowerment.
It’s easy for organizations to start using these techniques. One simple approach is for leaders to have an internal or external adviser versed in these methods to guide them in directly observing front-line work. Within 20 minutes leaders will see things that they haven’t learned in years of meetings. Bureaucracy is destroying more and more value in many health care systems, but it doesn’t have to be that way.
(Kenneth T. Segel is a cofounding principal and managing director of Value Capture.)