This post is an automatic translation from a text written in Slovenian. Translation is generated with use of DeepL Pro tool. Original text is postaed and available here: https://paradim.si/category/slovensko-zdravstvo-2022-23/
There are three areas of competence that come into play in the exercise of the managerial role. (1) The conceptual area is the ability to look at the whole and its individual parts. (2) The people domain refers to all competences in interpersonal relations: motivating, conflict resolution, building good relations and general climate, etc. (3) The technical domain refers to this sectoral expertise. This means the medical profession in the case of the exercise of this function in a medical institution, the teaching profession in an educational institution and so on.
In the “world of healthcare”, technical expertise is strongly emphasised and means a great deal to staff working in healthcare institutions. Working with people is a topic that is dealt with in management and is the subject of most of the content on this website. The theme of this paper is the conceptual part.
Managerial diagnostics
We have an elderly patient with several concurrent, combined illnesses. We are therefore faced with a condition that is known in the medical profession as co-morbidity, or polymorbidity. So we have several diseases at the same time, with different origins or to be treated by different specialists. So who or which department takes on such a patient? The one who does, takes responsibility: responsibility for health and responsibility for life. A few of the specialists describe this in conversation with each other as you. It is a “grey area” and “a matter of decision and agreement”. At the same time, as a source of great burden, interdepartmental conflict, and personal insecurity and fear.
In this report, of course, we are not interested in the symptoms of this doctor’s state of health, but in the symptoms of the state of the organisation. The experience of individuals, as it is called, points to inconsistencies or inadequacies in the design of the organisation. When something causes problems frequently, repeatedly and/or at a systemic level, it needs to be addressed systemically – it needs to be found at source and, for this purpose, we need to look into the structures put in place by the organisation.
I will continue with a selected hypothetical finding. Let me stress, of course: management is a professional role. A real solution would require a serious analysis, which would only then provide truly relevant solutions.
Is it the imperfection of the rules?
When something is described as a “grey area”, as undefined and as such a source of uncertainty and fear, more precise rules may be the solution. These are described in an organisation by a property called formalisation. So is the origin of the situation presented in the area of formalisation?
- What if we were to lay down precise rules for when a patient is taken in by this department and when by another department? This action would in itself mean that the responsibility for the action, rather than the individual who takes the decision, is taken by the rules, and that these rules are strictly followed. That so-called grey area can be completely closed, or at least greatly reduced.
- Let us move on. What if one day there is a young or less experienced doctor on the ward who does not feel competent enough to take on this patient? The responsible thing for such an individual to do is also to be realistic about his or her competence; the right decision is the one that will mean the best care for the patient.
The second part of the paper now shows us the nature of the managerial role and the conceptual ability needed to deal successfully: an organisation is made up of many elements, all of which must be interconnected and all of which must function properly. If we are to implement the changed rules, we must also make sure that our recruitment, induction and training systems work “seamlessly”. Everyone in this position must either be competent to carry out all the necessary tasks or have a mentor available at all times. If this is ensured, the system will work well and we will also describe the working conditions as good. Otherwise, the system will break down and the weight of the burden will be shifted onto the shoulders of the staff in the form of insecurity, fear, as well as the presence of conflicts and other symptoms.
Is the root cause elsewhere?
There are, of course, many other possible solutions to close this grey area. For example, it may be possible to have a different compartmentalisation. When we build a company or a public institution, we are used to grouping together (in departments) staff from the same discipline. So we have HR, production, marketing and other departments in a company. This is the way that is most “in the habit”. This is because it allows for good supervision and efficiency, which was very important in the traditional sense. In modern operations, we are increasingly focusing on quality. Efficiency is no longer the primary concern, but rather the creation of high added value is becoming more important. We want to integrate skills, we want to encourage the development of new approaches to problem solving, that is, innovation. We want to focus on the customer. We want to focus on the patient. The first is called a functional organisational structure, but today it is being replaced by process, project, matrix, team and other structures.
Message
Conceptual skills give an important message for the exercise of leadership. The action of the person exercising it must be holistic. The manager must not address solutions in a piecemeal or partial way, but must look at the organisation as a whole and provide systemic solutions. Any such systemic solution has a huge range of implications and impacts on performance. Each system solution has to respond to hundreds or thousands of events and situations that will occur in the course of the work. The manager has to detect these, be aware of them, think about them … and find solutions. It must design solutions, implement them and then monitor them, adapt them and develop them further. Management must be a professional role (also in healthcare).
Researchers point to the underestimation and professional undernourishment of this role in Slovenian healthcare. Not only that, but staff themselves often admit that they are not adequately prepared for the challenges they face in this role. We need either training for those who take on leadership roles or the appointment of people who are qualified for the role. We need new thinking in which deviations and inadequacies (for example, the symptoms of poor organisation addressed earlier) are recognised not as normalities and challenges for the medical profession, but as problem states that need to be addressed and that require specialist managerial knowledge. There needs to be a greater appreciation of the actions and skills or overall role involved in improving working conditions.
Sources in the design of the record:
Boršnak, T. and Sitar, A. S. (2021). Izzivi vodenja v zdravstvu: ugotovitve raziskave na podlagi teorije izmenjave vodja-sledilec. Izzivi managementu 8(1), pp. 4-14.
Dimovski, V. and Penger, S. (2008). Temelji managementa. Pearson Education Limited, Harlow.
Kovačič, H. and Rus, A. (2015). Leadership competences in Slovenian healthcare. Zdravstveno varstvo 54(1), pp. 11-17.
Paradim 