A major management challenge for hospital operators is the fact that hospitals are hybrid organisations.
They bring together, on one hand, a “solution shop” where professionals diagnose and solve problems. On the other hand they are “value added process management operations”, akin to an organised factory.
Clinicians need to deliver surgical treatments through organised, precise and often repetitive processes that minimise risk, maximise throughput and allow no room for mistakes. Devi Shetty’s success in this area, with his cutting-edge checklists, procedure specialisation and industrial style process management, has made him the study of hospital operators the world over.
In this way, hospitals are similar to manufacturers that have zero tolerance for errors and require total quality control. Getting processes right and reducing deviations in standardised procedures is a must for any precision based operation.
Yet a hospital is also “a solution shop”, full of highly experienced professionals who use their judgement to diagnose, prescribe and solve problems. This part of working in a hospital is more similar to organisations such as law firms, where professionals work directly with their customers in small teams, and have autonomy to design unique solutions in their customers’ best interests. The conundrum of hospital management is that this creative side of a hospital operation can seem diametrically opposed to the side that requires precision process management.
But for multidisciplinary hospitals the two have to go hand in hand. Studies show that there are three factors that make the difference in job satisfaction: autonomy, complexity, and relativity between effort and reward. The job of management in any sector is to provide employees with all three, so each person can deliver their best.
Across the world, there are hospitals which, in search of factory-like precision, have done the opposite. Attempts to micromanage professionals have taken their automony away; there have been attempts to simplify clinical pathways to such rigid degrees that they ignore the complexity of human anatomy; some reward everyone in the same way, regardless of their contribution or effort. In the worst cases, they have failed on all three fronts. The result is dissatisfaction and disenfranchisement among many healthcare professionals in many corners of the globe.
Hospitals should be organised no differently from other thriving professional services – where those closest to service users have control over the quality of service for those users, and are free to use their judgement and innovate creatively. Hospital leaders should give their healthcare professionals the responsibility and accountability to do their best for their patients. Yet this autonomy should come as part of a commitment to adhere to recognised best-in-class practices. Healthcare professionals should agree to standardise without deviation what can be done with precision, in order to problem solve creatively what calls for intuition and innovation.
Inevitably, aiming for these opposite disciplines creates potential for confusion. But balancing these tensions is what makes hospital leadership exciting and stimulating. The challenge is creating a new management model that brings these disciplines together like two sides of a coin. Dr Shetty has made a significant contribution by relentlessly and intelligently pushing back frontiers on precise process management in hospitals. For that he deserves our full attention and gratitude.