Delegation or Abrogation?

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By Jan Jennings

A Key Determinant To Organization Success or Failure…

On St. Patrick’s Day, our firm celebrated its fifth anniversary. It has been an interesting journey. We have served hospitals and healthcare organizations from sea-to-shining- sea, large and small; hospitals extremely well-managed and hospitals still trying to find their way. After serving or visiting dozens of hospitals, and before studying the data, you quickly develop a sense for the hospitals that are winning and those that, well, are still wandering around.

Three decades ago, the Dean of the School of Business at Duquesne University, Pittsburgh, Pennsylvania, coined the expression that “management” could be defined briefly as “getting things done through others.” Such an expression succinctly captures the complexity of delegation of responsibility within an organization. In general, the winning organizations that we observe have a system or delegating responsibility that works effectively. It is a combination of art and science. Joe Schmedlap, Chief Operating Officer of St. Smithers by the Swamp, in Broken Arrow, Oklahoma, has a system of delegating responsibility without losing control of the departments for which he is ultimately responsible to the Chief Executive Officer. He receives regular reports and measures success and occasional slippage within each department or cost center assigned to him. He seems to have a sixth-sense for when things are going well and when a department is floundering. It is more than pouring over reports and data. A lot of it comes from the tone and tenor of the human interactions between him and the incumbent department head.

It is not complicated. When you ask a department head a series of questions and clear crisp and enlightened answers snap back, you develop a confidence that the department manager has effective control over his area of responsibility. Indeed, it is within these organizations we normally find success by most any measure.

Unfortunately, we occasionally find a Chief Executive Officer or Chief Operating Officer who substitutes “abrogation” for “delegation.” One definition of abrogation is, . . . .” to treat as nonexistent.” In these circumstances there is a detachment between the “executive” and the “department head.” I refer to this as the “Pontius Pilate Syndrome (PPS).” Why should I preside over this issue when I can leave it to mob rule? PPS can be either active or passive.

Active PPS: We collect data with respect to productivity standards and present it to Augustus Caesar, Chief Operating Officer of the Walking Wounded System of Meandering Medical Centers, in God Lost Her Shoe, Mississippi. He seems to be listening attentively and then he utters these fatal words, “Take this information to my department heads and let them do with it as they will. I support my management team and I depend upon them to do their jobs.” I will pull them together and you can present these data to them and I am confident they will do the right thing. Upon further questioning, “Do you want us to get back to you with the result? The answer, “If there is anything that I need to know I am confident my department heads will bring it to my attention. I support my management team and they support me.”

Passive PPS: We collect data with respect to productivity standards and present the information to Melvin Milk-toast, Chief Operating Officer at Sinking Fast Medical Center, Off the Beaten Path, Minnesota. Before we can present the data, he makes it clear that productivity data is confusing and creates anxiety for his department heads. Rather than confuse the department heads with information and data he would prefer a ten percent across the board cut in full-time equivalents every three years. It is simple and everyone understands how it works. Also, most department heads leave within three years of employment so the system of across the board cuts only affects the department heads once in their tenure with the Sinking Fast Medical Center.

Hospitals in which there is rampant abrogation of responsibility by top management suffer several common outcomes. It does not matter if the hospital practices Active or Passive PPS. These characteristics are as follows:

These hospitals routinely lose money.

The department heads focus on finding a new job.

The Board of Directors grows increasingly restless.

Allow me to put all of this into sharp contrast with hospitals where effective delegation is practiced. Delegation is defined as, “to commit (powers, functions, etc.) to another as agent or deputy.” The department manager feels empowered to do his/her job with the effective mentoring and coaching of a leader. At Snappy Valley Medical Center, in Sharp Focused, Oklahoma, there is a regular flow of information in both directions between the Chief Operating Officer and his department heads. There are regular private and group meetings within the “management team.” There are common characteristics of those within hospitals who deploy effective delegation systems. They are:

These hospitals routinely have positive results from operations.

The department heads are taking on progressively higher levels of responsibility.

The Board of Directors has enormous confidence in the management of the hospital.

These are but a few observations made over the past five years. The most startling observation is how deeply embedded these divergent practices are enforced within hospitals. Organizational culture seems to have a life of its own and it is powerful. Well-run hospitals show a deep curiosity for information to advance the good purposes of the institution. Poorly run hospitals avoid, even punish, managers who challenge the status quo.

For the reader of this missive there is the obvious question. Is your organization involved in systematic delegation or abrogation? The answer matters. On a more personal level, which type of hospital do you serve? Your answers, whether open or anonymous will be greatly appreciated.