Monday, September 30, 2013

113. Loss of responsibility

In item 109 of this blog I discussed what I called system tragedy. Well-intentioned ideas and actions are laced together in a complex, interdependent system, with cross-overs and mutations, yielding outcomes that cannot be foreseen and that nobody wants, let alone intends. This is mingled with personal and institutional interests.

Under this complexity, managers, in business and government, cannot realize the responsibilities they assume. They cannot admit this, since that would eliminate their authority and position. Inevitably, they regularly fall into failure. When pressed, they have to admit this. Yet they maintain the illusion of control, ritualized in high remuneration and bonuses, rationalized by the difficulties and risks they face. They credit success to their actions and blame failure on complexities.

This remainds me of a scene in the film ‘Orfeu negro’, the story of Orpheus and Euridice in the setting of carnival in Rio. At the beginning of the film the hero plays the guitar at daybreak, to a ring of admiring youths who believe that the sun will rise because of his play. And then, indeed it does.

Like former robber barons, kings and dictators, managers strive to maintain their position, no longer with physical force but on the basis of mythmaking and indoctrination. Conduct is enforced by conformism. Criticism is needed to make problems visible, but it is discouraged by ostracism or dismissal. Blinded, organizations stumble into crises. Procedures are enforced to regulate even professional labour that cannot be forced into closed protocols. Little is left to personal imagination or interpretation. This kills variety. And motivation. And as I argued in the preceding item of this blog, closed systems are bound to fail, to lose life.

Ideology has been defined as what is in the interest of others for me to believe. Foucault showed how ideology is assimilated and accommodated in our subconscious. Culture is ideology embodied in institutions, in rules of language games. This serves to hide the interests behind ideology.

Risk avoidance and the drive to master complexity and uncertainty by more rules runs into limitations, professional and entrepreneurial resistance, and work-arounds to escape from them. The resulting gaps are patched up by yet more rules. This contributes to yet further complexity, resulting in further unpredictability and inability of control, and strangling initiative.

I end with an illustration. Presently, under the drive towards a market regime in health care, in the Netherlands, hospitals are forced to subject professional medical practice to protocols for diagnosis and treatment. This is needed for health insurers to judge efficieny and impose conditions for funding. Problems remain in the judgement of quality, and further rules are designed for it. Surgeons are only allowed to perform operations if they do them a minimum number of times per year. This yields concentration of complex treatments in larger hospitals. That yields a drive towards alliances or takeovers between hospitals, with all the problems involved. A political drive to control surging costs of health care leads to limits of funding. Hospital management is dependent on the community of specialists and does not dare to discipline them to prevent waste, expensive hobbyism, shirking, and corruption. The minister for health threatens to impose further controls. What is intended as a market is in fact an explosion of rules.

In this environment, it is almost impossible for managers to fulfill their tasks, and most managers are far from up to it. This leads to a ban on the reporting of problems, and a destruction of responsibility among both management and staff. This is about to erupt in public scandal.