Move Away from Top-Down Management

Move Away from Top-Down Management

As healthcare organizations try to navigate their way through the massive changes the industry is experiencing, executives are struggling with an additional challenge. Some management techniques once assumed to be best practices have generally come into question. One, top-down management, has caused a particularly acute problem in the healthcare industry. To move forward, executives will have to find new practices.

Top-down management is a relic of an old social construct that stretches back thousands of years. The person in charge was considered to be the most capable and the final voice of authority, ultimately a member of royalty assumed to have a divine right to rule. The attitude became incorporated into formal management structures and practices in the early part of the 20th century.

Top-down management assumed that decisions and ideas should always proceed from the top of the organization, down through a management hierarchy, and ultimately to workers who were expected to obey without question. At any level, the boss is assumed to always have the right answers for people below. Bosses drive the business and workers follow suit.

Many management theorists have come to recognize that the approach has some severe limitations, and in few industries is that as obvious as in healthcare. The “workers” are often highly trained professionals with an expertise of the business at hand – supporting and improving the health of patients – that far outstrips the knowledge and experience of many of their supervisors and executives. Not only are the decisions made by executives likely to be wrong in a top-down arrangement, but the results could literally threaten lives. The arrangement also harms morale among the expert line workers because the organization clearly does not appreciate or respect them.

Instead, healthcare organizations should consider alternative management practices. For example, at HealthEast Care System in St. Paul Minnesota, frontline workers gather every morning, review problems they’ve seen develop, and devise ways of solving them without the oversight of management.

The decentralization of analysis and improvement is part of a process called Plan-Do-Study-Act developed decades ago for manufacturing companies by the statistical quality expert and management consultant W. Edwards Deming. At the heart of the concept is the idea that flawed processes are generally the cause of problems and that controlling and improving the processes results in better operations and quality of work.

Specifically, a healthcare organization creates groups, or cells, in which new ideas can be tested and processes redesigned and standardized. Those successful developments are then spread across the organization. Managers learn to identify and focus on key metrics to monitor the operation and also to encourage staff to offer improvement ideas.

Eliminating the top-down structure makes all the resources of the organization available to focus on its improvement. It will take such radical management redesign to help the healthcare industry meet and best the challenges it faces.

Are you interested in finding a rewarding and lucrative healthcare career that fits your individual strengths and interests? Find out how education can help you adapt to the changing healthcare landscape. American Sentinel University is an innovative, accredited provider of healthcare management degrees, including an MBA Healthcare and Master of Science Business Intelligence and Analytics.

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