Friday Feature: Occam’s Razor and Management

When I have coached/mentored executives and senior management, I am always initially surprised by how much these folk want to complicate things. Healthcare is notorious for bureaucracy and to a large extent, folks that have worked only in healthcare have been socialized that complex regulations and rules and then, organizational systems for compliance wrapped with layers of policy and procedures are absolute necessities. Government likes its paperwork. Payers the same.

It is often said that healthcare is the most regulated or at minimum, the second most regulated industry in the U.S. Some would argue that nuclear energy is more regulated. Regardless, healthcare is complex but yet, there isn’t a requirement that the regulation-driven craziness must in turn, impact the business and what leadership/management does from an operating perspective. In other words, simplicity is possible in lots of ways.

Occam’s Razor is a principle that states that one should not increase entities or processes beyond reason, simply to explain or complete anything. In other words, when a committee isn’t required, don’t form one. When one policy suffices, no need to write multiple. When a policy isn’t required, don’t create one. When one layer of management is failing to achieve desired results, don’t add another layer. I could go on.

In healthcare, the first principle I try to drive into an executive is that the business model is truly about only two things: patient care and human capital (staffing). One requires the other and vice-versa. If the care is great and the staff are too or minimally, the staff are engaged and productive, a huge part of the operating requiem is being met. From this platform, great care, and great staff, everything else can flow with limited interruption and limited challenge. Sure, infrastructure is necessary, but frankly, it doesn’t require a whole bunch of layers or new bureaucracy. Arguably, and I have seen this happen, adding layers and new managers tends to reduce the quality of care, the productivity of staff, and then, the performance of staff. Success, for some reason, seems to breed the feeling that more operational structure is necessary, yet no real argument can be made via return on investment, for the same.

The primary objective of management is to achieve more while requiring and spending less. More succinctly, to create structure that is simple, consistent with the enterprise goal, rewards tied to outcomes, and people, in places with the capacity and capability, to produce the desired outcomes. Simple. As Steve Jobs would say, “tolerate only “A” players”. Leadership should exist to create a vision and form a structure that allows folks to swiftly and easily, incorporate the vision into an operating plan.

The application of Occam’s Razor to management and ultimately leadership, follows a pretty simple format. Mine is below. Happy Friday and enjoy the weekend!

1. Focus and evangelize that work is about a process of caring for the patient – nothing else matters.
2. In order to effectively perform #1 above, the work culture for staff must be interdependent – take care of each other.
3. Reward outcomes that are measurable and tied to #1.
4. Limit management and supervision to the bare essentials and fight against, additions thereto.
5. Minimize meetings and committees – empower staff and management to make decisions.
6. All business expenditures should be fundamentally tied to Return on Investment and a long view.
7. Overhead should be levered as frequently as possible.  Find capacity within.
8. Minimize policy and procedure to only that which is absolutely required.  Use protocols instead.
9. Don’t let regulations and industry focus cloud the operating parameters.  Most of the conferences, seminars, and association newsletters serve a purpose other than your business.  Use them solely for information, not a how-to.
10. Give feedback on how things are going.  Reward progress toward the goals and vision, often.  Skin in the game is how  and why “A” players remain.