Change management Leadership and Change

Break Down the Bureaucrats in 8 Steps.


I came across these eight symptoms of bureaucratic breakdown whilst listening to The Personal MBA: Master the Art of Business by Josh Kaufman.These eight symptoms resonated with me and align almost poetically with my experiences in health care. I hope that you will find them to be of value. Does this ring true for you? Let me know what you think.Josh Kaufman attributes this to Dr Michael Sutcliffe from the University of Cambridge.

  1. The Invisible Decision – No-one knows how or where decisions are made (there is no transparency).
  2. Unfinished Business – Too many tasks are started but very few carried through to the end.
  3. Co-ordination Paralysis – Nothing can be done without checking with a host of interconnected units.
  4. Nothing New – There are no radical ideas, inventions or lateral thinking—a general lack of initiative.
  5. Pseudo-problems – Minor issues become magnified out of all proportion.
  6. Embattled Centre – The centre battles for consistency and control against local/regional units.
  7. Negative deadlines – The deadlines for work become more important than the quality of the work being done.
  8. In-tray Domination – Individuals react to inputs, that is, whatever gets put in their in-tray, as opposed to using their own initiative.

Josh states that “If any of these qualities describe your daily work experience, your team is probably suffering from a case of Communication Overhead.

The solution to communication overhead is simple – make your team as small as possible. Read more on PersonalMBA.

One of the take home messages is that beyond 8 people, each new team member requires more investment in communication than they add in productive capacity. Including them is causing more work than it is adding in benefits.

Make teams as small and autonomous as possible – “Keep teams elite and surgical” – ‘Peopleware’ by Tom DeMarco and Timothy Lister

Equally, a team of one is also not productive, as can be the case in general practice. This guides some of the philosophy behind creating pods and teamlets such as in the Patient-Centred Medical Home model.

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