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/
The value of knowledge, society and knowledge culture. With its first real beginnings in Hellenistic Greece, and even today, the Slovenian psychologist Janek Musek incorporates some of the foundations of the same idea into the idea of the so-called society of the future. We have developed many fields of science, which allows us to tackle challenges from many different perspectives and thus with many different approaches. We therefore have an “unlimited” choice of how we approach a challenge, which area we address and in which area we look for solutions. All this has one very important contribution.
Demands on healthcare are increasing, the number of patients is increasing with an ageing population, and staff in the system are overstretched. It can be the case that one individual is ‘playing’ two, three or more roles at the same time. At the same time, he or she is appointed to run the outpatient clinic, answer the telephone, look after the patients’ room, and perhaps even answer the consular (say, specialist consultant) telephone. A specialist or a young doctor, because of a shortage in the staff, can quickly be given responsibility for people’s health and lives when he or she enters the system, for which he or she is not adequately prepared. A doctor may be given a few minutes to help a patient because of too many patients, even though this is not possible. In healthcare, we have many examples of working in the ‘impossible zone’. In the zone of what cannot be achieved and should not exist. And it is precisely this (widely developed) knowledge that allows us to close these zones for good and to look elsewhere for solutions.
Integrating or ensuring interdisciplinarity
What solutions do politicians, financiers, experts in organisation, communication, digitalisation and all the other disciplines see for the problems in healthcare? In the knowledge society, we have developed an approach that we have labelled “interdisciplinary”, and problems in this society should be addressed according to this approach. In modern management (and also in leadership), the importance of diversity and its integration into the functioning of the organisation is often emphasised. It is also (as has been repeatedly stressed in the record) the activation of the potential of (as wide a range of) people as possible. And it is management that has to ensure this: it cannot be held directly responsible for the results themselves, i.e. for the actions of all those involved, but it is responsible for the way (let’s call it mechanisms) in which the organisation operates.
Staffing, or who we include in the collective. The set of desirable and undesirable behaviours or the whole culture of action. Promotion rules and fairness in rewards. Established channels for feedback on individual performance. Availability of all information needed (for quality work). Provision of conditions for responding to perceived problems, for innovation and creativity in work. Defining the full range of roles necessary for successful performance. And more. Putting systems in place is what we put the management of a given organisation in charge of (and it is probably understandable why we refer to modern managers as enablers, servant leaders and the like).
In healthcare practice, however, there is an additional complexity. To capture the full complexity would require quite an extensive analysis, so I cannot offer you that (at least at the moment), but I can highlight some of the more prominent factors. In the national health system, the management function is divided between the ministry and the health institutions (or their management); the individual thus operates within the room for manoeuvre as defined at a higher hierarchical level within the health system. We also see an important feature that managerial positions (directors of health facilities) are occupied by doctors. From this we can see that professionalism in the health profession is strongly emphasised and stressed in the health system. This situation has been identified as problematic by several scholarly contributions (perhaps in a later post), and I think that certain questions are in order: how to incorporate more management (and leadership) expertise into the system, and is the current regulation necessary to maintain (medical) expertise? From abroad, we see a solution to this problem within the framework of a combined health and organisational education for all those in managerial positions in the health system.
The four functions of management
In describing the role of management, there is a familiar comparison with that of a conductor. The manager is the member of the organisation who knows what each part of the system needs to ‘sound like’ or add to in order to bring them together into a harmonious and fine-tuned orchestra. It is not a “super-role” or a “super-machine”, but a generalist profession that has to incorporate all the necessary (specific) expertise. It is therefore an integrating role, which shapes and establishes the underlying system and then integrates all the knowledge and competences needed for a successful operation.
Management as a role comprises four substantive parts:
1 Definition of the content of the activity. The first part describes the role, which is called planning. Planning means ‘imagining in advance future action’. It is the responsibility of management to ensure that the organisation has identified the main challenges it will address. For example, how will we address the (previously described) problems in healthcare? We can address the political sector and modernise the payment system. We can look at the organisation and develop a new role mapping that will allow us to do more with the staff we are given. We can also look at digitisation to automate processes, or communication to better communicate with the public (if we see, for example, that explanations, guidelines and other messages could replace an activity and relieve the burden on health staff). And so on. How or by what route will we get to the desired future?
2 Defining the form of action. This role is called organising and is best represented by the task of defining all the necessary roles. What do I do, what does my colleague do and is this a sensible allocation of tasks? Do I have all the necessary knowledge for the tasks I am faced with and does our department have all the necessary knowledge for the tasks it performs? Would we perhaps need additional interdisciplinarity? What skills and competences does each individual who will fill a role need, and what level of these skills and competences? Is there anything missing or needed in the organisation? Do we have enough support staff, such as technical support, communication support, administrative support, etc.?
3 Leadership. The third role, which often takes on the meaning of overall management in everyday vocabulary, is about ensuring performance. We want to ensure that the objectives set out in the first and second parts are achieved. Much has been written about leadership on this website, so here I am highlighting one component in particular: self-awareness. The leader shapes the culture of the organisation. He or she must be aware of himself or herself, of his or her actions, of his or her own communication and of the messages he or she is sending out to those around him or her. What does my criticism address and what does the award I have given reward? What do I want from the people working in this department? If an agreed task has not been (fully) completed, but extra work has been put in behind the scenes, our criticism can stifle any further potential extra work. We need to understand the situation first, and then communicate clearly what is desirable and undesirable behaviour, because we do not want to send the wrong messages. The leadership role is a ‘full-time’ role because it requires a lot of investment in the very soft elements of personal growth, such as self-awareness. The leader is the character from whom the members of the organisation draw their messages, and this in turn shapes the patterns of behaviour that the members in the department will follow. In this way, he or she builds a culture, which is another of the fundamental systems that drives performance and success at work.
4 Control or supervision. Ensure that the right path is followed, while leaving enough room for creativity and motivation. If we (as managers) want to be in control, we will (very likely) reduce or stifle both of these components. The public sector in general often restricts personal growth by closing the space for the development of authentic ways of working, where individuals can use their personal strengths to be more successful at work and build their self-esteem. Monitoring means providing feedback on the work (and thus pointing out any shortcomings), but also identifying how motivated individuals are to perform their roles and taking appropriate action where necessary.
Conclusion
Management, as a role in an organisation, sets the rules of engagement and thus has the most decisive influence of all roles in shaping working conditions. It is the role that is concerned with ensuring that we are properly inducted into the workplace, that we have opportunities to learn and develop our own careers, that we are properly rewarded for our work, that we have the opportunity to do quality work, that we have professional and other support and resources available to us, that we have all the skills and competencies needed to be successful, and so on. When we put management (i.e. the management team) in a position of “absolute” responsibility and expect them to be accountable for everything, we are entering a danger zone where we are encouraging the development of additional rules and constraints that give this management (absolute) control, and thus worsen the working conditions for other members of the organisation. It is certainly the responsibility of management to ensure that all the necessary systems exist in the organisation and that they are of sufficient quality.
This transcript is based on content from the study textbooks:
Dimovski, V. and Penger, S. (2008). Foundations of management. Pearson Education Limited, Harlow.
Dimovski, V., Penger, S., Peterlin, J., Grah, B., Turk, D., Šalamon, K. and Grošelj, M. (2014). Fundamentals of Management and Organisation. Faculty of Economics, Ljubljana.
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