Both these expressions have been in vogue at different times to describe great organisations. Can they both be right at the same time?
If Martians landed in the NHS and said to a doctor at random, “Take me to your leader”, what would he/she do? Personally, I would probably stammer, “Err, what do you mean? Do you mean the person I think is the head of my professional body (President of the Royal College), or the Chief Executive of the Trust I work in? Perhaps you mean my Clinical Director or is it the Medical Director? On the other hand, maybe it should be the Chief Medical Officer; no wait, what about the NHS’s Medical Director? That can’t be right, it must be the General Secretary of the BMA, or do I mean the GMC?” I imagine by now the Martian will be having second thoughts about visiting!
Is my indecision a symptom of an egalitarian, democratic Utopia where no-one needs to be ‘in charge’ since all are working towards a harmonious, unified goal? Or is it a ‘leaderful’ community, one where everyone takes a leadership responsibility and models great teamwork and mutual encouragement?
I guess no objective observer would ever describe the UK’s NHS as a great example of highly effective leadership. So perhaps my plethora of ‘leaders’ is more of a ‘leader-heavy’ institution, i.e. one where there are more ‘Chiefs than Indians’!
I watched a TV programme about what would happen to the world if all the humans left. It seemed that the world would ‘just get on with it’! I then got thinking about bureaucracy in the NHS and what would happen of all the managers left. Would anyone notice?
There’s an urban myth in medicine about a doctors’ strike in Australia (or was it New Zealand?). There was much hand-wringing by the chattering classes about all the terrible things that would happen to patients. In fact, the number of people dying during the period of the strike was less than normal! Doctors are dangerous. (You’ll be able to think of other reasons yourself). The counter-intuitive sometimes works out right.
So, what would happen if all the managers were sacked overnight? Probably not much. Patients would still turn up for their operations and doctors would still operate. There would be some disconcert when no salaries were paid into bank accounts, so perhaps we should keep the salaries and wages department!
The WHO reckons that one of the reasons the developing world’s health services are so poor is that they have no health managers. When I visited Malawi recently the head of a hospital was a surgeon with no managerial training who appeared daunted by the responsibility.
Can the lunatics really run the asylum? Probably; but would you dare try?