How Can I Change CYA?

Question to Ask the Workplace Doctors about covering up mistakes:

We have chain of command that seems to encourage a lot of cya on the part of middle managers–problems unsolved, good people who are problem solvers leaving because the next in the chain of command doesn’t function well or retaliates for bringing up problems. Is there a different management system that doesn’t reward cya, blaming, retaliation, and lack of problem solving and cover ups to protect self? Is chain of command an old outdated management style? If not, what is going wrong in our corporation? P.S. As a physician I am outside of the chain of command, but I have lost great workers who are under the nursing chain of command.

Signed, #NAME?

DearĀ #NAME?:

Losing good people frustrates you and hurts your medical organization. I’m sure your cya question begs for a quick fix and practical suggestions for a structure that generates a workplace that is both employee friendly and productive. Up front, I must confess that I know of no quick fix or management structure that will achieve that. However, just as there are accounting safeguards, such as two-person requirement for signing a check to protect against misuse of an organization’s money, there are some practices that can guard against arbitrary and selfish interested practices. Good Human Resource practices and enlightened management, in my opinion, are embedded in a team management system. I’ll describe that after a short trip across the history of the chain of command. I include this because your question requests some thought as to organizational structure. You can skip these next three paragraphs or just scan them.

The pyramid of chain of command has a long history and it works to the degree that those from the top to the bottom in that chain are motivated see their self-interest as interdependent on collective commitment. Management theory’s roots are in the military chain of command. About a hundred years ago, it was encapsulated in the term scientific management; meaning that efficiency and productivity could be had by time-motion piecework incentives. That was then modified by a series of studies that found motivation was not just based on pay, but on the need for job security and meaningful work. In the middle of this past century, bureaucratic principles of division of labor and regulations were introduced, like Civil Service, to remove favoritism. About that time, union influence and laws impacted labor-management relations–safety, working conditions and discrimination gained attention of management, and that has been for the most part positive.

Yet through all of this, the hard fact is that politics has never been eliminated from the world of work. Consequently, making decisions to save face and protect one’s ass are as much a part of the working world as is greed. Over past several decades, the term Total Quality Management has focused on cutting waste in many ways and more importantly on an ongoing commitment and practice of meeting the need for high quality of internal and external customers.Matrix management has been tried to achieve project-flexibility and has been used for huge projects, such as NASA. Matrix systems arrange managers and employees by function or product; matrix management combines functional and product departments in a dual authority system. I include here material from one study that found “between 1961 and 1978 about one-quarter of all teaching hospitals in the United States moved to unit or matrix management structures.

By the late 1970s, though, nearly one-third of those hospitals had rejected the concept, citing reasons such as high costs, excessive turnover, and interpersonal conflict. Although the hospital study suggested that matrix management was better suited to larger organizations, General Motors Corp.’s experience indicated otherwise. After a seven-year test of a matrix structure, GM jettisoned matrix management in the 1980s in favor of a more traditional, product oriented organizational structure. It cited managers’ lack of control over incentives as a primary shortcoming of the matrix system.” Matrix Management and Structure – duties, benefits Management scholars have proposed that because of the complexity of managing contingencies practices can best deal with the chaos of organizational life. I don’t subscribe to that metaphor. Rather I prefer a term I’ve coined that pictures great places in which to work as corporate-wide interdependently minded, what I call WEGO.

Structurally this is found in coops and in employee-owned organization; ones that have employees invested in and engaged in managing their workplaces. I am not informed enough to describe medical practices that are owned by doctors and professional personnel as you probably are. But I suggest that interdependent-mindedness entails more than psychological ownership; it means stakeholders are not just those with the most money. They are all those who invest of themselves and they must spell out overlapping team-like structures that guard against narrow cya self-interest. Few of us start from scratch in shaping our careers. Rather we seek out a workplace that is already organized, and some of us gradually earn credibility enough to shape the way it is managed. I expect that is where you are on your career path. You want to know how to affect your work organization in ways that might make it sensitive to the worth of those who are problem solvers and who have had the courage to voice their concerns for quality care. Might this mean that you and other doctors assert your say about nursing personnel by an oversight committee? Might this mean that you and others pilot/manage work-group profit centers? Might this mean that you and others voice your commitment to an organization-wide quality improvement effort, and consequently that would entail an active voice on management practice?

Management creates structure and is most effective when that structure is employee-considerate. The beginnings of realizing that might be voicing your unhappiness with cya and proposing ways to prevent it. Protecting the common good doesn’t just happen. It requires hammering out the rules that manage selfish behavior. This answer is longer than you probably have time for; however, I hope it helps you think through what would be site-specific to your workplace. Pondering answers to hurtful situations is grit for making a difference. Working together with hands, head, and heart takes and makes big WEGOS, and is that not really what you want–practices that conserve and foster what is good for all stakeholders; a common good and not self-face saving?

William Gorden