Health : Utter confusion

Written by Bernard Brault on 10/12/2010

I think it’s necessary for me to emphasize the main idea of my article dated March 27, 2010. Minister Bachand’s (Finances) and Minister Bolduc’s remarks are so ingenuous that I’d like to present our new readers the analysis we made last spring and our suggestions resulting from an obligation of Sound Management.

For our readers from abroad, which are more and more numerous, let me introduce you to our context. Last spring, Mr Bachand announced  in his budget a cut of the expenses for Quebec’s Government to allow a reduction of the deficit. This budget, forcing the taxpayers to pay higher taxes, was considered unfair by several. The Minister ensured that the government would also support 62% of the efforts by imposing cut expenses in all ministries.

An Utopy, without even talking about the resilient BUREAUCRACY, paralyzed even.

But nobody listens to us! It’s probably the same for you dear reader, wherever you are in the world.

An Utopy?

In March 2010,  I wrote the following :

We were already aware of it. However, a nice and brave deputy Mr Bonardel had the courage to bring to light out of the governmental red tape the process maps showing the managerial meanders of the largest sector of Quebec’s public service: the Health network. We pretend not to know anything, but we do. This is the bureaucracy. It’s been a long time since management, political sciences, and law students have studied this phenomenon by reading from well-known authors such as Crozier (1) and Etzioni (2) who have enriched our imagination and libraries. Among all the organizations created by people, taking into consideration all the political systems, the one with the highest chances of survival, which we call nowadays resilience, is undoubtedly the governmental bureaucracy. It has its own managerial language, its own ethical rules, and it is always capable to regenerate, to increase in number its decision-making members, and especially to cope with any external democratic power that might question its continuity. Let’s also consider the intervention of the unions and politics and the machine is completely out-of-order.

I think that the public service employees are honest professionals who generally are committed to serving people and accomplishing their tasks. The problem is that they are jointly working for a system not allowing them to see neither the inputs nor the purposes of their tasks. They are therefore lost in a diabolical machine out of their control, where nobody else wants to make decisions or, even less, to assume the responsibility of control losses and errors that could sometimes lead to serious consequences for the population’s health. Slogan: survive the diabolical machine until retirement.

The biblical reference to the Tower of Babel reflects the insane efforts of the people wanting to reach the sky (God’s kingdom). Nevertheless, the Tower was destroyed by the people’s incapacity to communicate, caused by the confusion of languages.

How can anybody even imagine, for instance, that a decision can be made by six different persons from six different authority levels and six different areas of competence? Or, that any of these acts could be undertaken without a risk assessment, an impact analysis, an agreement or approval, as well as a monitoring of the staff in less than 24 or 48 hours as long as the decision-makers are all at the same administrative level and none of them has a final saying in front of the others? Let’s add to this, the managerial “wolveness”, an administrative language that nobody understands, and a political intervention, and all this will soon resemble the Tower of Babel. The bureaucracy will go on, but the Tower will fall! Notice that the CHUM is still at the phase of making plans and cost estimates, for the third time.

Who will commit hara-kiri? It takes a lot of courage to recognize that the administrative unit we belong to plays a useless or superfluous role, if we take into account the socio-economic context; that holding a position such as internal consultant doesn’t imply in fact more than just filling in the forms for a possible consultation; that certain departments are in charge only of the study and entry of data regarding the staff management and the employees’ satisfaction and quality of life.

A 48-hour resourcing time in silence is suggested to the managerial staff. Others suggest that the overstressed managerial staff be sent at the emergencies for 48 hours to help the nurses, which would result in a natural silence as soon as they come back to work.

Within the Health network, some sources sustain that the proportion of the administrative staff compared to the employees is 3 to 1. Let’s not kid ourselves, nobody from outside this network, be it the Prime Minister, will ever be right regarding the administrative logic and the potential power of obstruction of the bureaucracy.

The core of the problem is not related to ethics, ideology, or not even to right-wing and left-wing politics, but to bureaucracy.

Of course, for more than 50 years, the business model, the authority-based relationships, the unions’ counter-balance, the isolation of the individual, the control procedures, and the concept of responsibility have diagonally evolved, or even have completely changed in the context of the Quebecker and Canadian public service.

One thing hasn’t changed though: human nature behaviour in a group of anonymous individuals. The larger it is, the more anarchic it becomes. Despite the best intentions of everybody, many individuals, bosses, managers, ministers, and vice-ministers were brought up short. An old adage says that “you have to pick your battles.”

Would it be possible, in spite of all these, to change something or to implement some more of the Sound Management concept to the public service?

In 1962, Michel Crozier(3) wrote, “so that there is real change, that the bureaucracy dissolves or at least diminishes, people need to acquire new abilities: personal abilities to cope with stress, collective abilities to organize and maintain the role playing based on some exchanges and grounds of defense.”

The Sound Management framework suggested by the ISM offers a management model easily adaptable to the complex structures, the delegations of authority, the control and audit, to the obligation of result, the accountability on behalf of the professional managers within the Health network.

The Sound Management concept doesn’t only imply the implementation of the principle of Transparency, as many would tend to think. In Sound Management, there are six principles that have to have a correspondent among the administrative acts, and no principle should be referred to the detriment of the other principles.

Implementation of a SMF within the Health network
Short term

First step: choosing some voluntary administrative units Government departments, network agencies, hospitals, CLSC, etc.

Second step: rigorous training

It is important to find the internal motivation for this change, starting from the lowest level up to the highest one. The Sound Management concept can’t be implemented against their will. Most certainly, this takes a well-planned training program starting with the managerial staff and the top management, and ending with the decision-makers.Unfortunately, the Sound Management can’t be taught in 2 hours, but more likely in 30 hours, and this only for the first level. As for the second level, it may take up to 45 hours of training!
For instance, DeVeaux Brault & Associés together with the regional Regroupements des CPE have developed a more simplified, 3-day training session for the executive directors of the CPEs. As a result, those CPEs have implemented the SMF in more than 300 organizations. Other companies from Québec or Outaouais, having the status of ISM members, may do the same.
Third step: self-diagnosis

Medium term

The Sound Management model is easily adaptable into a questionnaire adjusted to answer the 41 cells. A self-diagnosis guided by professionals will therefore be non-committal and will constitute the basis for the actions to be taken in order to implement the Sound Management values within the general framework of the Health network.

Forth step: establishing the non-compliant elements This implies to classify the management policies and rules present in the SMF, to establish what the missing parts are, and to fill up the blanks. Such an experimental exercise was performed for one of the Canadian Government departments in relation to the Treasury Board rules.

Medium or long term

Fifth step: Uniformity of the SMF in compliance with all the governmental policies and programs.
Implementing a SMF (Sound Management Framework) within the Health network, it would be a huge task, but not at all impossible.
Based on the experience accumulated during the past 20 years, the ISM would suggest a non coercive approach. Having contributed to the training of people working in public service and audit programs in the late 90’s, we are aware that the Sound Management approach deeply affects habits, attitudes, values related to the management process and its vocabulary. It strikes dead on the bureaucratic sluggishness but not on all the operational functioning. It would be wrong and unfair to give the impression that the entire governmental machinery is dysfunctional.
The Sound Management is especially a model that, thanks to the visual effects of its matrix and the 41 cells, makes efficient the organizational diagnosis and the methods used to adjust it. The Sound Management is like a big binder founded on logic thanks to which we can easily divide what’s compliant from what it isn’t with the OAAQ’s generally accepted Sound Management principles.
An honest support from all managers is fundamental.
It will be soon clear that those who feel threatened be more or less skeptic. We believe that the best way to implement an important change is to generate internal movements, which would raise the interest and curiosity about how the managers’ profession is enhanced through the Sound Management approach. At the same time, in order to train the managerial staff and the government senior public servants, we could tell you that the Sound Management approach is attractive and motivating on the condition sine qua non that the entire machine joins it.

(1) CROZIER Michel, Le phénomène bureaucratique. Éditions du Seuil, Paris 1963, p.11

(2) Etzioni Amitai, Les organisation modernes. Éditions J.Duculot, Gembloux 1971.

(3) CROZIER Michel, opcit p.11

Bernard Brault, F. Adm.A, Fcmc, is an expert consultant in Governance, in Managerial Ethics®, and in Sound Management. He is also the author of the following books: Exercer la saine gestion, Fondements, pratique et audit, and Le cadre de Saine Gestion, un modèle de gouvernance intégré, published by CCH.

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