Striving to thrive
SMTs aim to develop employee skills through cultivating autonomy, creativity, and resourcefulness. On the contrary, the very construction of bureaucracy has as its goal to restrict flexibility on the altar of rationalism and order.
Τhe interviewees expressed concerns about how leadership ‘above SMTs’ reacted when initiatives came from more junior (though newly empowered) staff and were often “not written in the protocol.”
Leaders were experienced as superficial in their communication with the front-line staff. While the instructions of managers are, in theory, clearly and strictly communicated in the traditional structures of the NHS, the research showed that how leadership is actually exercised is a personal issue, meaning that it remains as a matter for the discretion for each manager. There are leaders who are more compassionate, open to discussion and closer to their subordinates, leaving space for them, and others who are intervening and controlling and insist on the exact procedures to be followed.
The leaders of SMTs and their leaders were often being trained in leading in new ways, to fit the Buurtzorg SMT approach. However, the whole organisational performance management system was not also changing.
Thus the bureaucratic organisational system performance which assesses managers on the basis of how well their team perform continued as before. The mangers thus have to deal with a delicate balance in decision making between allowing SMTs freedom and managing them tightly to be sure they are ‘delivering’. Furthermore, the temptation was for managers to ‘impose’ workload on lower graded staff [against the tent of a SMT which would sort out its own work distribution]. It was found, in line with expectations from theory, that the lower the individual is in the hierarchy, the easier it is for others to increase their workload. As you go ‘up the organization’, hierarchy matters more and more, and seems to become more solid.
Some interviewed argued that the bureaucracy is linked with the employees’ perception about performance. Some turn to the organisational structure and its policies and procedures: have we followed them? Other focus on did we deliver the right care to meet our patient’s needs? The former process, trying to find the mistake in the policy rather than in the care delivered, also causes an increase to the workload.