HealthManagement, Volume 7 - Issue 2, 2012 HIT

Uncluttered Management Thinking

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Imagine an operating room with surgeons and scrub nurses operating on a patient. Imagine they all had a different understanding of the word ‘surgery’. Imagine they were unsure about their tasks, competencies, and responsibilities. Imagine they would evaluate their performance by the duration of the operation rather than by the outcome. Imagine they would handle the medical instruments by instinct rather than by mandatory education and years of experience. Unimaginable.

Thinking is uncluttered in the operation room. The medical language is clear and concise, as misunderstandings and failures lead to immediate adverse effects on patients’ well-being.

Uncluttered Thinking is Necessary for Management

It’s essential to think, speak and act in a right and uncluttered way in management too. Failures result in negative effects on quality, productivity, creation of value, use of resources and competitiveness of companies, organisations and whole countries. The satisfaction not only of employees, but of society as a whole depends in a large part on the quality of management decisions. Therefore, management is the most important profession in modern society. Anybody wishing to manage an organisation effectively should pay special attention to uncluttered management thinking.

Today, there are more people than ever before making managerial decisions. Whether they label themselves ‘managers’ or not does not matter: A chief physician in the hospital, a cancer scientist as group leader, a head nurse; they all have to manage themselves, the people around and their area of responsibility.

Whereas medicine has highest quality standards for education and licensure, no such thing exists in management. Generations of managers had to learn management mostly based on trial-and-error, intuition, and of course through their experience. University education in business mostly focuses on business administration, but not on management itself. Acknowledging the great responsibility of managers in all aspects of daily life, this is an unbearable situation.

Everybody Can Learn to Manage, Everybody Must Learn to Manage

Management lacks a common understanding. Instead, there exists a clutter of management methods, styles and often contradicting and doubtful management approaches. Too often, questions like ‘Who is an ideal manager?’ are discussed in the media, leading to unrealistic lists of criteria that no individual can possibly fulfill. Instead, the right question is ‘What should managers do?’. This shifts the perspective from management as an elite profession for special, chosen individuals to management as a mass profession that can be taught and learned by everyone.

The first and foremost responsibility of hospital managers is to transform resources to results and value for patients. This is the raison d´être for any hospital and the reason why managers are paid. People create value for patients. Therefore, managers have to manage and enable their employees to be able to dedicate themselves to doing that all day long. A central question must be: ‘How do we organise ourselves so that the employees really do what they are paid to do?’.

Management Principles as Basis for Effective Management

To ensure clear and concise management knowledge, a common understanding of the elements of this profession is fundamental. Uncluttered management thinking means to sieve out the necessary and sufficient elements that all managers must control in any location, in any situation, in any organisation, and at all times. Management principles are one of the elements of management as a profession.

Effective managers follow six principles that govern the quality of their daily work, the efficiency of the tasks they fulfill and the tools they use. Principles ensure that an organisation is based on a common understanding of management. Principles serve like a beacon in focusing on the right things instead the wrong things. No talent is required to understand and to follow management principles, the only things that are needed are insight and discipline. Whereas principles are no guarantee that an organisation will succeed, a lack of them will result in failure.

First Principle: Result Orientation

Thinking in results changes the perspective from work input and questions like ‘How long do I work every day’ to the resultoriented question ‘What have I achieved?’. The responsibility for any manager is to achieve results, to make sure that employees are able to produce results and that they can devote their working time to that. Result orientation coerces managers to think about the things that really matter to the organisation. As a consequence, it reveals many zeitgeist management tenets as harmful, e.g. the claim ‘work should be pleasurable’. Professions like critical care paramedics, ward physicians or the cleaning staff in operating rooms are not fun, yet society strongly relies on their accurate work. Hence, the focus must not be on input-driven factors like the degree of fun, but on the quality of the output and the achieved benefit for the patients. Cured patients as well as perfectly sterile operating rooms will provide pleasure, meaning and satisfaction to the responsible job holder.

Second Principle: Contribution to the Whole

This principle is the fastest way to achieve ‘holistic thinking’ in organisations in a down-to-earth manner. Effective managers think about their contribution to the whole by asking themselves: ‘Why am I on the payroll of this organisation?’ and: ‘What am I responsible for in this organisation?’. They demand that their subordinates be able to answer those questions too. Any evaluation on whether or not employees are spending their time doing the right things can only be carried out when the employees know what their contribution to the organisation is. This is especially true for knowledge-based organisations like hospitals where only highly trained specialists are able to create value for patients. Having said that, employing ‘specialists-only’ is dangerous for any organisation. They know their own reality but they are indifferent to the reality of the organisation, which causes significant communication problems and a loss of touch with reality. What is needed, are specialists who integrate themselves into the whole.

Third Principle: Concentrate on a Few Things

Let’s have a look at the operation room again. Imagine the surgeon answering a phone call during a heart surgery. Unimaginable again, as he focuses on the surgery, his really important task in that situation. Contrarily, in management there exists an outworn cliché of effective managers coping with many things simultaneously, which in fact has an adverse effect. As it is difficult today to focus on a few things, this principle has become even more important. There are some keys to concentration, e.g. management by objectives, an efficient personal working method or systematic abandonment of habits that distract from creating value for clients and patients.

Fourth Principle: Using Existing Strengths

The fourth principle is one of the keys for top results. Effective managers identify their own strengths and the strengths of their employees. The best method to recognise strengths are tasks where a person has already achieved good results. Matching individual strengths with a person’s job assignment is a direct, fast and economical way to achieve peak results. However, many organisations focus on attenuating weaknesses of their employees with time- and cost-intensive measures. The outcome is mediocrity and lack of motivation. These issues will not occur when the focus lies on strengths, as it makes weaknesses irrelevant and people concentrate on tasks they are good at.

Fifth Principle: Trust

What matters in the end is mutual trust. Mutual trust inside an organisation makes management situations more stable and robust enough to deal with management failures. To create trust, it’s necessary to follow a few simple rules: The subordinate’s mistakes are the boss’s mistakes, at least to the outside world and to the senior management. Mistakes made by the bosses are theirs alone without exceptions. The success of the subordinates is theirs alone. Caring about participative or authoritarian management style is not as important as creating trust, as there is no evidence that one or the other style per se leads to better results or to a more stable organisation. What matters is being genuine.

Sixth Principle: Positive Thinking

Positive thinking turns the manager’s attention from problem solving to opportunities, to make the best of a given situation with the available resources. As the things are as they are, the only difference managers can make is how they decide to perceive and react to them. This doesn’t mean that problems can be ignored, but it is an invitation to seek and find possibilities even in bigger problems and asking the question: ‘Is there an opportunity in this problem?’. Positive thinking is the step from dependency to self-determination. People who are able to motivate themselves, want primarily to change things, they want to act, and not simply recognise and passively adapt. This provides a significant competitive edge.

Principles as a Guideline for Uncluttered Management Thinking and Acting

These six management principles affect all kinds of management activities. They influence the development of organisational mission and strategy in terms of transforming existing strengths into future results. Principles influence the design of organisational structure, which should empower the employees to concentrate on their tasks without redundant coordination issues. Principles define organisational culture, which arises as an emergent criterion. This organisational culture in turn is mainly based on the personal role model of superiors in the organisation. Principles can be used as a foundation for the appropriate use of management tools and tasks, as they determine their alignment in an organisation.

Principles of management support the development of uncluttered management thinking. They provide an excellent framework to become more effective and efficient in creating value for clients and patients.

Fig 1: "Principles of Management"


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Imagine an operating room with surgeons and scrub nurses operating on a patient. Imagine they all had a different understanding of the word ‘surgery’....

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