Peter Drucker's brilliant 47-year-old idea could transform healthcare

There's a theme arising in the various conversations I've had about leadership lately: The front-line employees are the ones with the real power to transform an organization, leadership just guides them.

This, of course, is an intuitive concept, but one that isn't always embraced by leaders.

It's also a core tenet of a theory I've written about previously on this blog — Adaptive Design. Adaptive Design essentially argues that innovation doesn't come from a "big bang" disruption, but instead results from iterative adjustments to current practices and business models.

Another caveat of the theory worth highlighting is that it turns the traditional management approach on its head. In traditional management, information is sent up the chain, with managers and executives filtering this information and making decisions on how work should be carried out. Management's decisions are then sent back down the chain, where they're implemented.

Adaptive Design argues there's just too much data available today to send data up to managers for every decision; doing so creates a bottleneck that slows the organization's ability to adapt and adjust to market changes.

"Traditional management works great until the work becomes complex, dynamic and unpredictable, and you can't get data up [to management] quickly enough," says John Kenagy, MD, an innovation researcher who developed the theory of Adaptive Design.

Instead, the most successful organizations will cultivate a culture of decision making on the front-lines, by instituting processes and methods that support and encourage it.

There seems to be a groundswell of interest around empowering front-line leadership, perhaps because executives have begun to realize healthcare is just too complex to rely only on the top of the organization for action.

The Mayo Clinic Center for Innovation earlier this month released a book, "Thing Big, Start Small, Move Fast," which details the health system's process for curating innovative ideas from its front-line workers.

And, Chris Van Gorder, CEO of Scripps Health in San Diego, who helped lead a $150 million turnaround of the system, has a book due out in October, "The Front-Line Leader: Building an Organization from the Ground Up," which explores this very idea.

The approach is a worthy one. Healthcare is incredibly complex, and front-line workers often have more expertise to guide decisions than executives far removed from these processes and direct patient care.

However, the idea of front-line decision making is not a new one. In fact Peter Drucker, the father of management theory, predicted the need for this shift 47 years ago.

In an article for McKinsey Quarterly published in 1967 and re-released for the publication's 50th anniversary, Drucker explains how the traditional management approach of leaving decision making (which he refers to as "thinking") at the top of the organization inhibits the development of the next generation of leaders:


"On the other hand, we are going to open up a new problem of development at the middle-management level. It isn’t difficult for us to get people into middle management today. But it is going to be, because we shall need thinking people in the middle, not just at the top. The point at which we teach people to think will have to be moved further and further down the line." (emphasis mine)

Organizations today face the same challenge. Relying on a few experienced "thinkers" at the top of the organization to make business decisions may have worked in the past; it doesn't today. There is just too much data for a small group of individuals to comb through in order to adjust and adapt their organization quickly enough to remain competitive.  

Leaders who have accepted that front-line workers may be better suited for these decisions, and are able to train and empower a workforce to make decisions about their work in real time, are those hospital and health system boards should be seeking out.

If only we would have listened to Peter Drucker back in 1967, our healthcare delivery system might look a lot different than it does today.


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