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Trumped both ways: ‘Snake Oil’ or ‘Business as Usual’

14 September 2016

This week’s TWOG is co-authored with John Breitner, after we realized that our discussions about the U.S. election led us from different political perspectives to the same conclusion.

One of us is American and the other Canadian, one conservative, the other liberal.  We live in Canada, a good vantage whence to watch the U.S. election.  Where, we wish to ask, are the good folks of America, in politics and in the population? In the population they appear to be marginalized by a choice between one politician who is selling snake oil, 21st century style, and another who epitomizes the establishment that many of them abhor—business as usual.

This week’s TWOG is co-authored with John Breitner, after we realized that our discussions about the U.S. election led us from different political perspectives to the same conclusion.

One of us is American and the other Canadian, one conservative, the other liberal.  We live in Canada, a good vantage whence to watch the U.S. election.  Where, we wish to ask, are the good folks of America, in politics and in the population? In the population they appear to be marginalized by a choice between one politician who is selling snake oil, 21st century style, and another who epitomizes the establishment that many of them abhor—business as usual.

Donald Trump gives voice to many Americans who know that they are getting bamboozled. Yet here is the ultimate hustler, the very type who does so much of the bamboozling. Trust me, he says. Hillary Clinton gives voice to many who appreciate how dangerous her opponent could be. Trust me, she too says, while offering a steady stream of reasons why people cannot.  Sure we all have our flaws, but among 320 million Americans, could two not be found with flaws that reveal an underlying integrity? 

How is anyone to believe that either candidate will deal with the deeply-rooted problems of America today: income disparities, the legal corruption of political donations, a warming globe that needs to be cooled, crony capitalism that has harmed so much of the American middle class? Add to this the ultimate problem: an uncanny tendency to deal with all these fires by repeatedly pouring oil on them.

How, exactly, will the hotshot with the checkered background, who promises to “make America great again”, do that?  How will the archetype of the American establishment challenge that establishment?  And how will either of these two, who used to socialize together as members of the 1%, improve the lot of the 99%?

Americans have been hearing the “trust me” line for centuries. Lincoln famously claimed that you can’t fool all of the people all of the time.  Maybe so, but it appears that you can fool many of the people much of the time because, to quote P.T. Barnum, a sucker is born every minute.  So, evidently, is a shark.  Ask the contractors and workers of Atlantic City who sued the Donald for reneging on his contracts.

Trump, of course, also offers business as usual—in his case, quite literally.  I’m a businessman, he says. I can do it.  We’ve heard that before too.  Even if we leave aside that government is not business, even if we ignore the record of so much of today’s business as usual—all the lobbying, pay-to-play donations, corporate social irresponsibility, and the obscenity of executive compensation—we still have to ask what kind of a businessman is Donald Trump anyway?  Was he serious when he offered to renegotiate the U.S. federal debt to solve the deficit problem?  Or when he asked that an American-born judge of Mexican descent be recused from hearing complaints about his infamous “Trump University”?

What, then, are the good folks of America to do? When two people engage in a battle, both can look bad, even though one may have been worse. They drag each other down. No-one should be fooled by this. We believe that the calculus of the U.S. election is quite simple. The flaws of these two candidates hardly deserve the equal attention they are getting in some of the correct media. One is flawed, but the other could be fatally flawed. Business as usual may be intolerable, but snake oil for the ills of this world is downright hazardous. What Donald Trump would do as president is anyone’s guess; what Hillary Clinton would do is not.

So the American among us will hold his nose and vote Democratic. Then both of us will take a deep breath and contemplate the bigger issue: how can good folks save democracy from itself?  We urge you to do likewise.

© Henry Mintzberg and John Breitner 2016.  John is Director of the Center for Studies on Prevention of Alzheimer’s Disease at the Douglas Hospital Research Center in Montreal, and a Professor of Psychiatry in the McGill University Faculty of Medicine. Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing hereTo help disseminate these blogs, we also have a Facebook page and a LinkedIn page.

Confronting Socially Transmitted Epidemics

2 September 2016

Today this TWOG is 2. On 2 September 2014, I wrote: “Welcome to my TWOG—Tweet2Blog. Rousing reflections in a page or 2 beyond pithy pronouncements in a sentence or 2.” So maybe it’s time to look back and ask myself what all this has been about.

Mostly, I have decided, these TWOGs have been about socially transmitted epidemics: pathological practices in society that spread like wildfire, causing considerable devastation. We need to see each of these for what it is, and to get it by reframing it so that we can do something about it.

Today this TWOG is 2. On 2 September 2014, I wrote: “Welcome to my TWOG—Tweet2Blog. Rousing reflections in a page or 2 beyond pithy pronouncements in a sentence or 2.” So maybe it’s time to look back and ask myself what all this has been about.

Mostly, I have decided, these TWOGs have been about socially transmitted epidemics: pathological practices in society that spread like wildfire, causing considerable devastation. We need to see each of these for what it is, and to get it by reframing it so that we can do something about it.

Seeing it   These socially transmitted epidemics range from mismanaging (including organizing defectively, measuring excessively, and training mistakenly) to the mother of them all, imbalance in society (the domination of private sector forces). In between are executive bonuses and income disparities, pharmaceutical pricing, gun control (in the U.S. at least), climate change, and others.

Getting it   We may see most of these epidemics, but that doesn’t mean we get them, in our souls, and behaviors. For example, most of us see climate change, and do get it—in our heads. But how many of us get it in our practices? (That’s inconvenient.) We may see mismanagement all around us, but how many of us understand its full consequences, let alone its causes. I have railed on about the dysfunctions of conventional management education, which I see as a main cause of this mismanagement, and have backed this up with a study of Harvard’s superstar graduates, most of whom failed as CEOs. This raised not a single alarm bell. Do we not want to get it?

I am amazed at the extent to which these epidemics fester. How, for example, do we tolerate pharmaceutical pricing for one day longer? Likewise, why is it that the more outrageous is executive compensation, the worse it gets?

Reframing it   Hence I have devoted considerable attention to reframing—attempting to shift our understanding of these epidemics so that we can get them. To understand gun control in America, ask yourself if people there have the right to bear nuclear arms. To face the defects of globalization, think worldly. To reverse mismanagement, understand its separation from leadership on one side and from communityship on the other. Appreciate that effective managing is about scrambled eggs more than bottom lines.

To challenge pharmaceutical pricing, recognize that a patent is a monopoly, granted by a government. (How can any government allow its citizens to die for want of available medicines that could be affordable? That’s manslaughter.) 1 To understand the imbalance that enables such pricing, appreciate that the Berlin Wall fell on us. Capitalism has triumphed since then, not before that. To do something about this imbalance, recognize that there are three sectors in society, not two, and that the forgotten one—the plural sector, of you, me, and our communities—will have to galvanize our governments and businesses into serious action.

Doing something about it   This is where TWOGs stop. They are collections of electrons, from my e-thing to yours, hopefully having passed through my brain and into yours, so that they can reach our hands and our feet, for action. When a medical epidemic is recognized, the progressive world goes into action. Well, here are all kinds of social epidemics causing untold damage; they need attention. At the ripe young age of 77 (Happy birthday to me!), after years of being the good academic, now I am active. Maybe you are too; otherwise I can assure you that it’s not too late.

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I wrote in my first TWOG that “I intend to do this at most weekly, to avoid doing it at worst weakly, feeding the beast with all sorts of provocative and profound fun.” I have been true to that, skipping just one week in two years. It has been fun, for me and I hope for you too. But to avoid doing it weakly, I think I should stop doing it weekly. Time to confront the beast. So look for these TWOGs about every other week. Both of us already have quite the agenda of epidemics awaiting out attention.

© Henry Mintzberg 2016. My special thanks to Simon Hudson, who has been the rock between the place of hard data and my soft ideas.

Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing hereTo help disseminate these blogs, we also have a Facebook page and a LinkedIn page.


1 On Tuesday, an article in the New York Times reported that “The raging debate over EpiPen pricing has offered a surprisingly wide window into the complicated world of prescription drug pricing…” Are you kidding? There is nothing complicated about this scandal at all. 

 

Analyst: Analyze Thyself

24 August 2016

Photo credit: Ian ThompsonCC BY-SA 2.0

“It is a well-known axiom that what is not measured can’t be managed” (Kaplan and Porter in the opening of their 2011 Harvard Business Review article “How to solve the cost crisis in health care”). This is well-known all right, and false, not to mention downright silly.

Photo credit: Ian ThompsonCC BY-SA 2.0

“It is a well-known axiom that what is not measured can’t be managed” (Kaplan and Porter in the opening of their 2011 Harvard Business Review article “How to solve the cost crisis in health care”). This is well-known all right, and false, not to mention downright silly.

Who ever successfully measured culture, leadership, even the potential for a truly new product? Can none of these thus be managed? Did Kaplan and Porter measure the effectiveness of their own recommendations? Indeed, who has even tried to measure the performance of measurement itself, aside from assuming that it is marvelous? And how about measuring the performance of management? (Don’t tell me that increase in share price does this for the CEO. See “The tricky task of measuring managers.”) I guess, therefore, measurement and management can’t be managed.

Guess what? They can. We just have to understand that many of the things that matter most in organizations (and in life) cannot be measured, yet they have to be managed, whether personally or organizationally. Certainly we have to measure what we can; we just cannot allow ourselves to be mesmerized by measurement―which we so often are.

In this article, Kaplan and Porter (2011) provide a list of seven steps “to estimate the total costs of treating...patient populations”:

1.    Select the medical condition [specifying the possible “complications and comorbidities"]

2.    Define the care delivery value chain…which charts the principal activities

3.    Develop process maps for each activity

4.    Obtain time estimates for each process

5.    Estimate the cost of supplying patient care resources

6.    Estimate the capacity of each resource and calculate the capacity cost rate

7.    Calculate the total cost of patient care

Don’t look for:

8.    Include the costs of doing all this.

But you can get a sense of it by reading the authors’ example of a knee replacement, for which 77 activities are listed.1 Multiply this by elbows, hips, brains, hearts and minds, etc., factor in the frequency of improvements in these activities, which may come one at a time, and you have to wonder if analysts will soon outnumber clinicians in health care.

But the direct costs of their efforts are not the only costs. How about the costs of the distractions to the clinicians―for example, by having to record so much data―plus the costs of the political battles that ensue over who is measuring what, how, where, when, and for whom. Analysts see measurements as objective; contrast this with the political blood spilled over determining them.

Imagine if analysts put themselves through the same scrutiny as some do everyone else. In other words, imagine if they analyzed themselves. Maybe then, instead, we would get more of the following:

Years ago, the British retailer Marks and Spencer decided it was spending too much money controlling the movement of stock in its stores. So instead of a clerk filling out an order form to replenish a shelf, which was handed to another clerk behind a counter, who went to fetch the items, etc., the company got rid of the whole procedure and simply let the clerks go in the back and scoop up what they needed. The company was able to function with thousands fewer clerks and 26 million fewer cards and papers.

Now that’s truly efficient­­, and a vote of faith in the honesty of the clerks. Health care administrators take note: treated with respect, left to figure out many things for themselves, health care professionals can prove to be at least as trustworthy as store clerks.

© Henry Mintzberg 2016. Excerpted from my new book Managing the Myths of Health Care (forthcoming in 2017).

Follow this TWOG on Twitter @mintzberg141, or receive the blogs directly in your inbox by subscribing hereTo help disseminate these blogs, we now also have a Facebook page and a LinkedIn page.

 


1 Not to mention that “Outcomes for any medical condition or patient population should be measured along multiple dimensions, including survival, ability to function, duration of care, discomfort and complications, and the sustainability of recovery” (p. 5).