It is clear to me and many other people now that most of our institutions and large organizations are not functioning well.
I mean by this, that they cost ever more and increasingly fail to deliver their services in a timely and proper manner. Think of healthcare, education and many for-profit businesses.
My premise is that the chain of command has been taken over by bureaucracies and hiring and promotion has been taken over by credentials. In effect, large organizations have been dehumanized. Their life blood has been sucked out of them: making them toxic for workers and frustrating for customers.
Everyone loses.
To explain what I mean, let’s look at how pilots are still developed and deployed and then how nurses are today.
The Cockpit - Still works as a human system
In the pilot world, what matters is how well you fly. Given any emergency, will you have a good chance of bringing the plane and its passengers back alive? Flying is a high-stakes profession, where it is usually routine, but where you are in the cockpit to save the day.
The cockpit is an ideal example of a human organization where competence and sound behaviour is still mandatory. There is also a clear hierarchy. The Captain is in charge. There is no dilution to his authority in the cockpit. That authority extends to his superiors in the airline. If the Captain feels he has to make a call because he thinks there is a risk, the Captain overrules everyone. The responsibility for flying or not is exclusively on the Captain’s shoulders.
You are initially selected on your ability to fly. No other criteria comes close.
You begin your career by getting a pilot’s licence. Of course, there are lots of theory classes, but what matters is how well you fly. Flying is not a subjective matter. You go solo when your instructor observes that you are ready. Those who the instructors feel are inadequate are sent home. Some of us will never make good pilots.
All pilots have a logbook. Your logbook is no fantasy. Every hour you fly is recorded as is every type of plane. Each type of plane demands a test. Your log book is a true record of your competence. The logbook is your lifetime CV as a pilot.
If you get a job with an airline. Then you will sit in the right-hand seat and be tutored by your Captain. Every flight is a lesson both for you and for your Captain. For nothing teaches you more than teaching.
Hours are the central measurement. There is always more to learn is the premise. Learning comes through experience is the model.
You will be assessed by all the Captains you fly with. Promotion to the left-hand seat depends on your reputation, which in turn is based on this assessment by the people you fly with. Promotion is by ability and the airline’s capacity to find a Captain’s seat for you. In turn, experienced Captains are subject to being assessed by Check Pilots.
In flying, the test is always going on and is always based on a direct assessment of your competency.
A critical part of flying is the culture of the cockpit. There is a vast amount of research on this as the human factors concerning the relationships are the arena for most pilot errors and so mishaps. If you would like to learn more about “Crew Resource Management this link will take you there. Some of this learning have been introduced into Operating Rooms that share these kind of culture risks.
The worst culture is authoritarian. I am the Captain and cannot be questioned. There is a famous case of a crash of Korean Airlines 801 in Guam where the first officer could see the problem but was not assertive enough to call the Captain out. The second worst is permissive. An equally famous case is a Russian pilot allowing his young son to fly the plane.
The ideal culture is authoritative. Here the Captain is in charge but always open to questions, and where the Captain gives the first officer as much flying time as possible. The most famous example being United Flight 232 where it took 3 pilots and the Chief Steward to land the plane that has lost all its controls. They used the throttle.
Like other organizations today, airlines have vast bureaucracies that breach the managerial chain of command in other areas of the enterprise. But this does not take place in the cockpit. It is still too risky to insert a bureaucracy there.
Hospital Nursing - A human system that used to work but now has fallen victim to the the cancer of the industrial model
You would think that Nursing might be the same as flying. A role that can be routine until that moment when it is a crisis. It was, but is no more.
Until as late as the 1970’s nurses trained on the job while working in the front line of patient care. As they learned by doing, new nurses were supervised by Charge Nurses, Charge Nurses by Sisters and the Sisters by Matron. There was a clear chain of command rooted in experience. Sisters and Matron’s led from the front, like Centurions did in the Legions.
Like pilots, there was theory, but Nurses were taught by doing and by being exposed to ever more complex situations. There was always a more experienced nurse close at hand. The chain of command was based on a combination of nursing and later also administrative skill.
Significant responsibility was baked into the system. Sisters were important people. Matron was God! Like a RSM, she stood shoulder to shoulder with the senior physician.
Today in North America, Nurses rarely train in a patient setting. They inhabit a school/classroom setting where theory takes the front seat. Learning is mainly classroom-based. Patient care, once the core, is peripheral. Paper credentials have replaced an expert assessment by practitioners.
The vital managerial roles are now exclusively held for graduates of yet more schools or by non-medical “Managers”.
What this means in practice is that on a floor, the senior nursing staff have had relatively little practical experience and so cannot mentor juniors. Senior nurses spend most of their in reporting mode. The third-party bureaucrats have invaded and now consume the energy of the so-called nursing managers with their bureaucratic demands. Nurses are on their own. Immediate feedback from a more experienced practitioner is more limited.
I could go on.
True learning, agency and authority have been removed but not the load or blame if things go wrong. Because the chain of command has been broken, there is no longer any humanity in important processes such as the schedule. Matron or Sister might have been frightening but they all had been young nurses once and understood you. Now Nurses are scheduled and managed as pieces on a chess board. Having once been a source of great satisfaction, nursing has become a great source of stress and despair.
For the patient, the access and the quality of care has been reduced.
The bureaucracy leeches resources like a parasite. Now a significant amount of the payroll costs in the system is allocated to administrators. Savings are made in the front line. Patients meet the stressed front line staff and all suffer.
Timeliness is also lost as all processes are now burdened with a massive bureaucratic brake. Form filling and reporting take up time. In the guise of safety many simple things are made complex.
Most importantly development and learning, that used to take place in the workplace has been moved to schools and yet more credentials. Pass the test replaces show me how well you can do this. Competency falls as a result.
Finally, there is the spiritual issue. By removing agency and so creating helplessness, the bureaucracy has crushed the spirit of nursing. Many nurses now feel like drudges.
The same is true in most large organizations.
All is not lost. In later posts we will look at other organizations that have not given into Bureaucratization. We will also look at how more and more families are rejecting Credentialization as the goal of their children’s education.