Dr John Lockley identifies key areas for streamlining management processes and supporting your staff 

lockley john

We all know that evolution is ‘the survival of the fittest’. But there’s another way of expressing the same idea: ‘Evolution is the demise of the least fit.’ Nor is evolution limited to the natural world. Organisations can evolve—and very effectively, too. 

But have you ever wondered how nature managed to evolve plants and animals so beautifully without involving hordes of managers with data requests, incentive schemes, organisational charts, technical operating reports, RAG ratings, and the like? In fact these controlling influences are all there: you just can’t see them. They’re contained in those six words: ‘the demise of the least fit’. It’s the overall results that count: if they’re duff, the organism dies. 

The danger with imposed management is that it’s often inelegant, easily gets out of hand, may cost a fortune, and can impede and intrude upon everything. So we need to learn from nature. For evolution to occur in business we must consciously let ineffective or inessential units, procedures, and processes go to the wall (something we are not very good at). We need to recognise that propping up failing organisations is actually bad for everyone. Brutal, but true—indeed, exactly how nature does it.

What’s the point of management? 

What’s the point of management in the NHS? It’s to service the front-line troops, and the more efficiently, the better. 

You’ve put in an IT system—but have you remembered to kill off everything that relates to the unnecessary processing of paper? Or is your practice still receiving lab results in the post, as well as electronically? Unnecessary duplication like this is the very opposite of efficiency. Staff now have to read and process two sets of results, ensure they don’t send duplicate instructions to the patients; and deal with the confusion within the organisation when instructions are attached to one identical result, but not the other. 

Good managers seek to make themselves redundant … 

The cure? After an initial period of checking that the electronic results are being relayed accurately, make a positive decision to turn off the paper results: don’t accept them, don’t read them, don’t respond to them— and if they do come in, file them in the shredder. And if you think this approach is potentially dangerous, try working out the relative risks of wasting large amounts of staff time dealing unnecessarily with paper when there are so many other mission-critical jobs that are not yet being performed thoroughly. 

Creating efficient processes

The same goes for creating an efficient organisation. The simpler the organisation becomes, the cheaper the management costs; the simpler the management procedures, the quicker, less intrusive, and more effective they will be. 

Imagine Manager A has two members of staff (B and C) who report to him. Manager A takes the input from B and, based on it, creates instructions for C. But wouldn’t it be far better if Manager A asked B to liaise directly with C—thus avoiding the need for A to be involved at all unless something pretty unusual happened? 

Manager A has thus minimised the time spent looking after (or even thinking about) this particular process and can instead use his expertise for other things; and B and C can get on with the job without having always to wait for A to make a decision. 

Note that this is the exact opposite of how poor managers work: they often try to make themselves indispensable (or alternatively, are too scared to delegate). By comparison, Manager A is trying to make himself redundant, and in doing so has created a more efficient system.

The ultimate version of this is to aim as far as possible to set up systems that self-regulate, rather like fitting a thermostat on a radiator. 

So, kill off unnecessary or intrusive processes; and make the remaining ones automatic wherever possible.

Say goodbye to… unnecessary meetings 

What’s the point of a meeting? (Yes, seriously.) Think about: 

  • do you need the meeting? (Could you take the decision yourself?) 
  • do you need to meet regularly (or, that regularly)? 
  • would the meeting function better with fewer invitees? (Meetings with large numbers of people inevitably limit individual contributions) 
  • if its purpose is to spread ideas, would a document or a video work as well/better? 
  • do you need to meet physically? Why not arrange to have the meeting online, thus saving on travel and room costs and above all, time? Travelling to meetings can be a huge waste of a lot of people’s time and this time overhead can often deter the busier contributors from attending 
  • could you use a list server such as the NHS-approved Yammer as a replacement for a meeting, or to continue the discussion in writing? Using a list server can be like having a continuous committee meeting, where all members can contribute without needing to be in the same place at the same time, and very importantly can have democratic discussions and decisions in between the face-to-face meetings. (It’s good to have some face-to-face meetings, but it’s also very helpful to have other discussions—especially about urgent matters—on the list server.) 

So what do you do here? Go on, be ruthless! Evolve your organisation. Kill off ineffective meetings!

Inappropriate promotion

In the NHS, people frequently end up working outside their real areas of expertise. How often are brilliant hands-on clinicians ‘promoted’ into management or IT, for which they may have no particular training, inclination, or temperament? (You’d never do it the other way round: ‘Hi! You’re a great lay manager, why don’t we make you a ward sister?’)

Similarly, how often do we promote people to a level beyond which they can cope? This is The Peter principle:1The cream rises until it sours’. As it’s then often difficult to demote them, they get left in their new position, fouling up their new job—and in the process causing mayhem to those they manage. (The corollary to the Peter principle is that ‘eventually, under continuous promotion, every post-holder will be out of their depth.’) 

The cure (again, ruthlessly) is to build in clear strategies to (gently and legally) demote people who, after a trial period in the job, turn out to have been over-promoted. The result? All staff can confidently occupy the highest position of which they are capable, and all their juniors can enjoy unwaveringly decent managerial direction, for a change. 

Finally, try to use people at the top end of their abilities and delegate their lesser functions to more junior members of staff. By doing this, as we discovered in the July 2016 article on delegation,2 an organisation can gain an extra half-time practice manager for the cost of a junior member of staff. 

Go on—be ruthless! Say goodbye to the incompetents and utilise the rest to the very best of their abilities.

Empire builders 

Empire builders are the curse of the NHS. These can often be self-important people with second-class brains who are dedicated to promoting their own importance, which they measure by the size of their budget, or the number of staff they control, rather than by the quality of the job they perform. They are also very expensive. 

Why are Empire builders expensive? The cost of a manager isn’t measured by their salary; a far better yardstick is the amount of resource they use up, including other people’s time.

How much of this extra activity is necessary? How much time is being taken up with internal organisational matters as opposed to getting stuff out of the door? How many of the unit’s internal surveys actually improve output? Are meetings just talking shops or—just as bad— committees whose real purpose is to remove responsibility from individual managers, on the basis that you can sue an individual but not a committee? 

If staff are frequently in back-to-back meetings, when do they get the time to do the real work? Do you really need the entire committee of 40 in attendance to make a decision that really only involves five of them, thus wasting the time of the other 35? 

The bigger the empire, the more ‘internal resistance’ it has (i.e. effort that is wasted on internal matters, because of log-jams and over-complex internal cross-checking). Here, output is minimised simply because every project has to go before so many individuals and committees, with layers of management, consultation, and feedback. 

It’s also much easier to keep tabs on an organisation that is organised simply, with clear lines of communication and clear lines of responsibility. 

So say goodbye to an unnecessarily complicated organisational structure. Everyone will thank you. 

Looking after your staff 

  • Look after your staff: it’s good for them, and the goodwill you give will be repaid to you many times over in terms of loyalty. You will also have created a unit where people want to work, so you’ll attract better applicants 
  • Look out for your staff: guard their backs! Don’t let them get overloaded; if necessary, prioritise for them. Think to yourself: is what you’re asking them to do truly important in the overall scheme of things? 
  • Avoid a tick-box mentality. Tick-boxes are intended to be a proxy for identifying ‘good behaviour’—they aren’t. You may have created a protocol for passing on information round the practice (tick!), but the real question is, do you actually use it? Remember Einstein’s dictum: ‘Not everything that can be measured matters, and not everything that matters can be measured.’ 
  • Be honest: how can you truly measure the value of a receptionist who genuinely smiles at each patient? Wherever possible, ditch tick-boxes. Almost by definition, you can’t measure a profession by using them.

Doing it right 

Really efficient management respects all the above principles. And if you’re like the good Manager A, who ‘tries to make himself redundant’, then don’t worry—you’ll never be out of a job! As soon as more senior people see how efficiently you’ve organised your own unit, you’ll get headhunted, probably at a much increased salary.