5 tips for 2020

Since the start of this blog in 2017 I have written 36 blogs, which were read by over a thousand readers. So far it has been a very rewarding way of sharing findings and ideas related to my PhD research because I got in touch with a lot of new people and had nice and interesting conversations about it with people I already knew. Most of the blogs have had an analytic and observative character, but with the start of a new year, it’s time to share some tips on what to do with this in 2020.

1: Embrace complexity 

Complexity is about seeing an (or multiple) organization as a system of interrelated and interacting elements. Often in hospitals a system perspective is perceived as similar to viewing a hospital as a factory, with patients as products and doctors as robots, something completely standardized, but inhuman. During the observations in my research nurses or doctors I was observing more than once said to me: ‘oh, are you going to assess how efficient we work?’ This is not what a system perspective is about, or should be about. It is about knowing how the hospitals works, what for example happens when the capacity planner is on sick leave, what happens when the Central Sterilization Department is outsourced or how we can organize work for doctors and nurses in such a way that they perform at their best. The social network analysis for example clearly shows that if the three hospital coordinators are absent, then the coordination of surgeries, beds and materials will probably be much worse, leading to cancelled surgeries and long waiting times for everyone. It also shows that hospitals are not coordinated by managers so when they are not there, little goes wrong in the short run. It shows that simply moving out a part of the network and outsourcing it to somewhere else, without wondering what the interactions are about, is a stupid idea. The hospital system works when specialised people with skills and knowledge interact well, when IT systems and spaces are connected and so on. Knowing the complexity, accepting, or even embracing this, is important.

2: Accept the reality in order to change it

You now may think that I believe outsourcing is bad. Well, I don’t. Sometimes it has become a reality, as a result of one thing or another. It can be the best idea given the circumstances. Mergers are another real phenomenon that are often debated in terms of good or bad. Although we know from research that mergers do not lead to better performing hospitals, as it appears, mergers are also a reality. Simply debating if it is a good or a bad idea, is a bit pointless when it already happened, but arguing it is best for everyone, is nonsense as well. So, when a merger happens, make sure that the new system stays coherent and people stay or are connected. Sometimes there is a tendency to focus entirely on the new reality, trying to break from how things are now, thereby losing the coherence within the system. Preserve what is working well. Again, you need to understand and like to know the complexity. You may not like complexity, and I agree it can be overwhelming. Therefore tip 3 is important.

3: Make simple what can be made simple

It may sound as a contrast to complexity, but making some things more simple is an important prerequisite for better performing hospitals. For example data should be managed. It may not be the most appealing task – most people want to manage people, not data – but it has to be done. If there are five different names for every surgery, material, room or function in the hospital, complexity becomes a monster. It is like American, German and Chinese people working together, without a common language but still pretending to understand one another. It sounds a bit surreal, but I have seen it happen often.

Further, doctors and nurses are often not the best at data management – and why should they be. Instead of leaving it up to them and then blaming them for having no discipline or being sloppy about it, we have to help them getting this sorted. There are plenty of other people who excel in structuring large data sets and who appreciate doing this important task. Hire these people and let them service those who coordinate hospital logistics and capacity management (i.e. nurses, doctors, hospital coordinators).

4: Debate and reinvent hospital leadership

If those who manage the hospital do not have strong links with the operational system nor are they central in the network , as shown by the social network analysis, there is a serious risk of disjointed strategy and operations. Central agents in the network (see last year’s blog on this) have no formal hierarchical position but are actually leading the network, at least to a certain extent. This too comes with risks, in case these people are not informed or aware of the strategic impact of what they are doing. I think it is one of the major important challenges for hospitals to connect or even better, align strategy and operations. We have to move away from the traditional hierarchical structure thinking, as this does not reflect how leadership in hospitals works. This is not a new thought- and a lot has been written about it – but in practice, in my experience, for some reason people still act as though this is the way things work. We need management to overview the network, to see from the top of the mountain how things are (not) connected, to make sure that connections that are needed are there and that cooperation is effective. In that case they participate in the network as a sort of lookout high up the mountain. And if they ever feel like nobody is paying attention to what they are saying (as I guess hospital’s managers must be feeling like sometimes), perhaps they are too far away. A motto like ‘if you can’t beat them join them’, may be helpful. So go down into the valley to make the right connections!

5: Tips always come in fives but I have already reached my limit-for-the-maximum number-of-words-in-blogs. So I will finish off with wishing you all the best for 2020. Hope to be in touch in the new year!

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