Editor’s Note: This content has been excerpted from “What Organizational Diagnostics Do You Use to Detect Management Issues?” Journal of Healthcare Management, vol. 68, no. 5, by Eric W. Ford, PhD, FACHE. It has been edited down for length.
One of the privileges of editing the Journal of Healthcare Management is the access it gives to a large audience of practicing executives, and they provide great feedback. In fact, I rarely need to brainstorm a topic for this space, as the readership provides timely and important insights to review.
With that in mind, I would like to ask for thoughts on organizational diagnostics: What are the readily apparent clues to you that something is amiss in an organization? Are some of the cues counterintuitive in nature?
For example, a common problem in organizations today is the establishment of positions that can deny a request but lack the jurisdiction to say yes. In addition to creating what I call an “asymmetry of authority,” these positions frequently serve only one purpose: to be a gatekeeper to innovation and initiative. Largely superfluous, these roles often seek to justify their existence by creating make-work for others. Therefore, they are not only a waste of resources in their own right, they are also systematically reducing the efficiency and effectiveness of others.
Two rapid diagnostics for asymmetry of authority issues are Byzantine documentation regimes and submission processes that require multiple iterations to successfully clear the initial review. A third diagnostic—long lags in the response process coupled with short filing time frames to essentially run out the clock—is notorious. A classic instance of that in healthcare is filing an insurance claim. There are numerous key performance indicators designed to do nothing but track insurance claim collection times, amounts and the internal errors that caused delays.
Naturally, getting paid for services rendered is essential for survival. However, the time, effort and resources that go into claims management have become a cause célèbre in policy circles and have been offered as one rationale for moving to a state-run, single-payer model for insurance.
Undoubtedly, there are other organizational diagnostics that ACHE members rely upon in their day-to-day work. Please send any that come to mind, along with examples, to ewford@gmail.com. I will compile and share them (carefully redacting identities) in a future issue of the Journal of Healthcare Management.
Eric W. Ford, PhD, is editor, Journal of Healthcare Management.