The Economist runs a regular column, Guru, in its Management section. The column, which is a quick read and worth glancing at regularly, reviews management theorists, researchers, or academics who have had significant impact on thought in the fields of leadership, organizational dynamics, economics, or similar business related disciplines. Last week's Guru column (May 1) commented on the research of the organizational psychologist Elliott Jaques (1917-2003). The topic was differentiation between "the boss" and "the real boss" in business systems. If you are a regular reader of this blog, you won't be surprised to learn that I was drawn to consider whether, and how, this distinction applies to health care leaders.
Results Time Horizon Makes the Real Boss
The column summarizes Jacques' thesis stating that he:
...believed that people had a "boss" and a "real boss". The boss was the person to whom they were nominally responsible, while the real boss was the person to whom they turned to get decisions crucial to the continuation of their work.
This was a correlate to Jacques' observation that managerial and worker behavior varied based on the time horizon of the manager's accountability. In his research,, he determined that managers concerned with short term results were unlikely to make the most thoughtful long term decisions about working conditions. As a result, workers seeking changes to working conditions that were beneficial in the long run (but might compromise short term results) needed to engage in dysfunctional "level skipping" in order to get a manager whose results time horizon was longer to consider requests in a broader perspective.
While the immediate manager was the nominal boss - with direct authority over the worker, the "longer horizon" manager was considered the "real boss" - the one who could actually make the critical decisions the led to meaningful change in the employee's work experience. Jacques requisite organization theory (RO) holds that all businesses have seven levels of hierarchy, corresponding to time horizons of "real" managerial effectiveness: "...he found that people with a results time horizon of less than three months treated those with a horizon of 3-12 months as their real bosses, and so on up the scale."
True or False in Health Care?
Leadership effectiveness as a "results time-frame" dependent function is a provocative consideration for both business and health care. Rather than managerial or worker "behavior" peculiarities, is this the reason for most "level skipping" behavior? Can "level skipping" be diminished, and morale improved, in medical, nursing, and support service staffs by better "results horizon" education and training at all levels? Would longer results horizons at the health care delivery front lines negatively impact short term operational effectiveness and efficiency in laboratories, clinics, and ambulatory care centers?
As a health care leader, you are responsible for setting the results time horizon of your subordinates. How much emphasis will you put on short v. long term results, and what will be the price for your decision? Are results time horizons always layered hierarchically?
Is it Always So?
Consider the following:
- Are tenured academic medical center faculty, whose results time horizons are in some ways infinite, really more inclined to make sound long horizon decisions?
- Are health care executive leaders in your organization incentivized for short or long term results? How does that impact their decision making about long term investments in improving front line operations?
- How well informed are bottom level line health care managers in your organization about long term strategy? Do they push for short term results that compromise long term success?
- Is front line innovation supported or thwarted by results time horizons in your health care organization? Can you both support innovation for long term improvement and maintain short term operational performance?
- Is "level skipping" pervasive in your organization? Does it create internal tension? Is mismatch in results time horizon assignment part of the problem
Not having read the source material from Jacques I wonder whether layering of results time horizons amounts to built in functionality (keeping each level focused on the tasks at hand) or dysfunction (promoting short sightedness and discouraging innovation and long term investment). Health care leaders will need to consider this carefully as part of internal organizational communications strategy.
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