Monday, August 5, 2013

So, You Want A Bureaucracy To Manage Your Healthcare

Why don't bureaucracies produce the expected results?  We've all heard of and experienced the gross incompetence of public and private sector bureaucracies.  Who hasn't been insulted and outraged by the bureaucracy you were required to deal with by some enterprise or government entity?  And when you add organized labor into the mix, it becomes even more frustrating, annoying and aggravating.  What is it about a bureaucracy that allows well-intentioned collaboration to become an unmanageable behemoth, consistently failing to deliver the expected results?

Let's begin with the individual.  Most of us, if not all of us, begin our journeys with hopes, dreams and aspirations.  However, it is truly the rare individual who converts those visions into a lifelong pursuit.  (In some cases, these rare persons unwittingly trap themselves in a bureaucracy, e.g., civilian and military pilots.)  The rest of us continue to fantasize while either conforming to societal expectations or simply allowing events and circumstances to determine our fate.  The difference between those that pursue and those that don't is the extent to which passion and determination fuels their energy and ambition, and keeps their focus on their pursuit.

Generally speaking, bureaucracies don't attract those with passion.  Bureaucracies attract those who seek safety, security, acceptance and approval, and who make career decisions based on immediate opportunities, personal needs, issues and desires; which pretty much describes the rest of us.  Consequently, the workforce of a bureaucracy is comprised of individuals who chose the default selection for a career.  It's not what they would do if they believed they had the power of self-determination.  Not exactly the kind of person essential to a culture of excellence.

Then, we put this person in a job that is routine, repetitive, and/or tedious.  The job offers little challenge after you’ve learned it, almost no fulfillment or satisfaction and does not encourage creativity or imagination.  This promotes increasing focus and attention on things unrelated to the task at hand but which provides a diversion from the daily drudgery .  Eventually, the thrill and anticipation of a new career are replaced by resignation, frustration, dissatisfaction and envy.  And for those grappling with serious personal issues, they become disgruntled and uncooperative employees putting increasing distance between themselves and those whom they serve.

For those with some semblance of ambition, and desire for recognition, achievement and advancement, a bureaucracy can be a pretty good place to fulfill those desires.  Bureaucracies need managers and administrators just like any other enterprise.  The question becomes, how to manage an ascending career without jeopordizing the benefits that brought them here in the first place.  The unintended consequence is management spends more time looking up the organization than looking down.  The rank and file soon realize management isn’t working for them and that they are being ignored.  Collective-bargaining is unintentionally invited into the organization and universally embraced even by those who never thought they would wear a “union” label.

All of this combines to create the ideal environment for a rigid and unchangeable structure.  Since creativity and imagination are not encouraged, and because job security is paramount, decision making introduces risk and invites complications.  Consequently, policies, procedures, standardization, rules and regulations become the order of the day, all in the name of efficiency.  Employees soon learn to serve the organization, and that serving the “greater good” affords much more safety and security than serving the individual.


The real issue lies in the expectations of those for whom the bureaucracy was intended to serve.  Simply put, the customer expects excellence without fault which, almost by definition, is impossible for the bureaucracy to deliver.  And while many private sector bureaucracies manage to overcome their inherent tendencies, there is not one example of a federal bureaucracy which has ever exceeded the taxpayers expectations in terms of efficiency, responsiveness and sincerety.

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