Business as the best way?

(See also “Managing Government, Governing Management,” Harvard Business Review, 16 June 2016)

Is business really the best way to manage government, also health care?

Government certainly needs to be managed, but management also needs to be governed. It cannot just be let loose on public services, especially in the form of the “New Public Management” that imitates fashionable practices in business. Governments no more need to be run like businesses than businesses need to be run like governments.

The New Public Management, a label for old corporate practices, seeks to (a) isolate public services, so that (b) each can be run by an individual manager, who is (c) held accountable for quantitate measures of performance, while (d) treating the recipients of these services as “customers.” Let’s take a look at all this.

Am I a customer of my government?  I am a citizen, thank you, not a customer who buys public services at arm’s length in the marketplace of caveat emptor (“let the buyer beware”). Do I really need to be called a “customer” to be treated decently? I may be a customer of the state lottery, but, frankly, does government have any business encouraging me to gamble.

Can government services be isolated from each other, as well as from political influence, so they can be managed by their managers?  Sure sometimes—back to that state lottery. But how about diplomacy, and so much else? Should a government have one brand manager for waging a war, and another, separately, for diplomatic negotiations to end it?

Does government have a bottom line? Governments have many bottom lines—protection of citizens, education of children, and so on—many of which can not only be vague and conflicting, but also difficult to measure (as discussed in Myth 7 of the book).

Is just government bureaucratic, required to loosen up?  Ask people who work in big business about that. (Better still, read Dilbert.) It is no coincidence that two of the most popular one best ways in the history of management—time and motion studies to control employees’ hands and strategic planning systems to control managers brains—have been embraced most enthusiastically by communist governments and Weston corporations.

As a consequence of all this, much of public service now ambles about like an amnesiac, pretending to be business. And so does much of health care.

I am not my doctors’ customer, thank you. Nor are doctors human resources who need to be “empowered” as workers. They are human beings, who are engaged as professionals. Like nurses and other health care professionals, they work as conscientiously as they do, in the face of so much pressure and frustration, because they practice a calling. As Abe Fuks, Dean of Medicine at McGill University,  put it, they have “a latent drive…to do the right thing.”

As for hospital services, do I really want to be a buyer who needs to beware? I have to give them my trust Instead, I have to give them my trust, because I have no easy way to judge their performance. More generally, I don’t “consume” health care services because that way, they might consume me. And to any manager in a hospital who needs a mission statement, I say: find a job somewhere else.