A surrealistic mega-analysis of redisorganization theories
Andrew D. Oxman(1), David L. Sackett(2), Iain Chalmers(3), Trine E Prescott(3)
SUMMARY
Background We are sick and tired of being
redisorganized.
Objective To systematically review the
empirical evidence for organizational theories
and repeated reorganizations.
Methods We did not find anything worth
reading, other than Dilbert, so we fantasized.
Unfortunately, our fantasies may well resemble
many people’s realities. We are sorry
about this, but it is not our fault.
Results We discovered many reasons for
repeated reorganizations, the most common
being ‘no good reason’. We estimated that trillions
of dollars are being spent on strategic
and organizational planning activities each
year, thus providing lots of good reasons for
hundreds of thousands of people, including
us, to get into the business. New leaders who
are intoxicated with the prospect of change
further fuel perpetual cycles of redisorganization.
We identified eight indicators of successful
redisorganizations, including large
consultancy fees paid to friends and relatives.
Conclusions We propose the establishment
of ethics committees to review all future
redisorganization proposals in order to put a
stop to uncontrolled, unplanned experimentation
inflicted on providers and users of the
health services.
INTRODUCTION
HARLOT(a) was commissioned by PSEUD (an international organization for the Preservation of the Status-quo through Evasion, Unreason, and Diversion) to systematically review the literature on reorganization. We were offered not much money and 10 days to respond. After spending 8 days developing four strategic plans, undergoing three reorganizations, and going to a concert, we got started. Our preliminary search yielded 2526 organizational theories, 2 600 000 links (Google: organization theory; accessed 20 July 2005), 1309 books (Amazon: organizational theory; accessed 20 July 2005), 1811 hits in MEDLINE (PubMed: organizational theory; accessed 20 July 2005), and one empirical study. Not having time to sort through all this garbage, we considered several different methodologies for synthesizing this ‘literature’, including meta-analysis, bestevidence synthesis, qualitative synthesis, chaos synthesis, ethnographic synthesis, vote counting, random sampling, focus groups with 18 month olds, and realist synthesis. Given the amount of money we were offered and the boring nature of the topic, we elected to use surrealistic synthesis, a term that we coined to highlight the innovativeness of our venture and hide the fact that we do not know what we are talking about, nor it seems, does anyone else.
METHODS
We used the following inclusion criteria for our review:
- Population: We considered restricting our review to healthcare personnel, but there was no point in doing so in light of the predominant conceptualizations of healthcare workers as assembly line workers (in modern theories), entrepreneurs (in post-modern theories), and as galactic hitchhikers (in theories that go beyond postmodernism into new realms of reality).
- Interventions: Anything that anyone has ever done to anyone (particularly to us) in the name of reorganization, reengineering, modernization, effectivization, revitalization, transformation, devolution, centralization, strategic planning, risk management or crisis maximization, regardless of whether it was well intentioned or not .
- Outcomes: The consequences had to make us either laugh or cry or both (depending on how seriously we took them)
- Study design: Story telling. We used the standard for research in this field: at least one organizational consultant has to have been paid at least once for having said whatever the study concludes. We included studies that generated reorganizational recommendations that we could not understand (99.99%). We excluded studies that did not offer a reorganization plan (0.01%).
Search methods
We browsed the web a bit, sat around and
chatted for an enjoyable weekend, asked a
few people who are actually interested in the
topic what they think, circulated drafts of this
article to a few buddies, and made up the
rest. We recorded interviews and focus
groups between organizational consultants
and reorganized health workers, managers,
ministers of health, and academics. Unfortunately,
a recently reorganized company
(DILBERT plc) produced the batteries for our
recorder and we later discovered that our
tapes were blank. None of us can remember
much of what was said, so we have faked that
part of our review.
Data collection
We used a large trash bin on wheels.
Analysis
We measured the heat:light ratio of consultants’
recommendations when they were
raised to Fahrenheit 451. We also used some
fluorescent colours in our data summaries
because bright colours increase credibility
and statistical power.
RESULTS
We discovered that the literature is almost impenetrable due to creative jargon and the meaningless terminology generated by a variety of cults adhering to different beliefs and led by competing gurus. An abridged glossary decoding some of these terms is attached to this report (Box 1). Each cult has its own theory (Table 1), none of which is particularly coherent. These theories all use complicated diagrams called organograms (Figure 1) and support the OFF theory of research utilization. OFF can be summarized as follows: ‘you don’t need a theory’ (b). Although thousands of articles and books have been written about these theories, the concepts they contain are remarkably simple and overlapping. These concepts are summarized here.
Box 1
Glossary of redisorganizational strategies
Centralization (syn: merging, coordination): When you have lots of money and want credit for dispensing it.
Decentralization (syn: devolution, regionalization): When you have run out of money and want to pass the buck (i.e. the blame, not the money) down and out.
Accordianization: When you need to keep everyone confused by instituting continuous cycles of centralization and decentralization. Best example: the NHS.
Equalization: When you have not (yet) sorted out which side is going to win Interpositionization: When you need to insert shock-absorbing lackeys between patients and managers to protect the latter from being held accountable (this strategy is often misrepresented as an attempt to help patients).
Indecisionization trees: When you are massively uncertain and incompetent, picking numbers out of the air and placing them in diagrams. Also used as a party game at management retreats.
Matrixization structure: When your indecision tree has been exposed as meaningless twaddle, the introduction of a second indecision tree at right angles to it.
Obfuscasization: When you need to hide the fact that you have not a clue what is really going on, or what you should do about it. Makes heavy use of phrases such as ‘at this moment in time’ instead of ‘now’, and transforms things that are simple and obvious into complicated and impenetrable muddles.
R&Dization: When you have been exposed as a power-mad fraud and are offered a compensation package just to get you out of town. Employs the‘Rake it in and Disappear’ ploy.
Black hole effect: When a reorganization absorbs large amounts of money and human resources without producing any measurable output.
Honesty: When your corporate conscience urges you to admit that when you say, ‘It’s not the money it’s the principle’, it is the money. A dangerous and abandoned strategy, included here for historic purposes only.
Why reorganize?
We identified several over-lapping reasons
for reorganizations, including money,
revenge, money, elections, money, newly
appointed leaders, money, unemployment,
money, power-hunger, money, simple greed,
money, boredom, and no apparent reason at
all. Because we wanted to muscle in on this
consultation market, we attempted to estimate
the extent of financial incentives for
reorganizations. To our delight, the advice
business is booming. Estimated income rose
from around 20 billion dollars per year in
1990 to over 100 billion in 2000(c). Of course,
nobody seems to know Centralization (syn:
merging, coordination): When you have lots
of money and want credit for dispensing it
Decentralization (syn: devolution, regionalization): When you have run out of money
and want to pass the buck (i.e. the blame, not
the money) down and out Accordianization:
When you need to keep everyone confused by
instituting continuous cycles of centralization
and decentralization. Best example: the NHS
Equalization:When you have not (yet) sorted
out which side is going to win Interpositionization:
When you need to insert shockabsorbing
lackeys between patients and managers
to protect the latter from being held
accountable (this strategy is often misrepresented
as an attempt to help patients) Indecisionization
trees: When you are massively
uncertain and incompetent, picking numbers
out of the air and placing them in diagrams.
Also used as a party game at management
retreats Matrixization structure: When your
indecision tree has been exposed as meaningless
twaddle, the introduction of a second
indecision tree at right angles to it Obfuscasization:
When you need to hide the fact that
you have not a clue what is really going on, or
what you should do about it. Makes heavy
use of phrases such as ‘at this moment in
time’ instead of ‘now’, and transforms things
that are simple and obvious into complicated
and impenetrable muddles R&Dization: When
you have been exposed as a power-mad fraud
and are offered a compensation package just
to get you out of town. Employs the ‘Rake it
in and Disappear’ ploy Black hole effect:
When a reorganization absorbs large amounts
of money and human resources without producing
any measurable output Honesty:When
your corporate conscience urges you to
admit that when you say, ‘It’s not the money
it’s the principle’, it is the money. A dangerous
and abandoned strategy, included here
for historic purposes only. Box 1 Glossary of
redisorganizational strategies quite what the
business is, let alone whether it delivers value
for money. Consultants typically refuse to
provide any evidence on the efficacy of their
recommendations by pleading client confidentiality
and hiding behind opaque terms
such as ‘value propositions’ and ‘service
offerings’.
We were unable to find any reliable estimates
of how often newly elected governments,
new academic deans, and other newly
appointed leaders reorganize, so we unblushingly
guessed at it. Based on a non-systematic
survey of our own painful experience, we
estimate that ‘regime change’ results in reorganization
roughly 99% of the time.
The benefits of reorganization in terms of
consultant employment are undeniable. The
largest consulting companies (such as
Earnest & Old, McOutley and Cost- Dirthouse)
each have over 50 000 employees and
there are tens of thousands of smaller companies.
Almost a third of MBA graduates go into
consulting, lured by starting salaries for top
graduates of $120 000 a year (plus tuition
reimbursement and bonuses). Consulting
companies are getting worried that they are
drawing too heavily on business schools, and
are now tapping new sources of recruits,
such as PhD programmes, medical schools,
and art courses(c).
Beyond the hundreds of thousands of people
who are gainfully employed as consultants,
the amount of time that employees in
virtually every modern organization are
forced to spend on strategic and organizational
planning is astounding, even to us at
HARLOT. A conservative estimate of 1 day
per year per employee spent in strategic planning
and at organizational retreats (not to
mention leadership courses and team building
adventures) would suggest that trillions
of dollars are being spent on these activities
each year. This figure does not include costcentres in the hotel, restaurant and travel
industries.
| Table 1 Organizational theories and their diagnostic signs | ||
| Theory | Pathological features | Diagnostic signs |
| Bushian | An imperial and moralistic approach, couched in ‘good old boy’ chatter. Popular among inarticulate, inept leaders as an alternative to thought | Proponents are unable to pronounce the word ‘nuclear’ |
| Disjointed incrementalism | Advocacy of ‘muddling through’ rather than rational planning models | Recent evidence of a failed reorganization basedon rationality |
| Kafkaesquian | Surreal distortion and a sense of impending danger | Proponents are suffering from redisorganization, in an effort to explain their experience |
| Orwellian | Futuristic totalitarian approach to organizing | Big Brother |
| Machiavellian | Expediency, deceit, and cunning | Proponents are strong, authoritarian, benevolent leaders (often misinterpreted) |
| Maoist | Permanent revolution and great leaps forward | Proponents think you are talking about John when you quote Lenin |
| Modern | Characterizes health professionals as assembly workers and patients as automobiles. Stresses supervision, division of labour,time and motion studies, and the work ethic | Proponents are business school graduates of 1960–1989 |
| Post-modern | Psychedelic networks of poly-centres that fold and unfold | Proponents are business school graduates ≥1990 |
| Von Clausewitzian | Equates organizational planning with war, and highlights the need to seize on unforeseen opportunities | Proponents are retired generals or young geeks who grew up playing video games. Explanations written in dense Prussian |
| Sun Tzuian | Like von Clausewitzian theory, but with a greater emphasis on deception | Proponents are Western wannabe mystics |
| Ultra-self-centred celebretarian | Ignores the expectations of all but its proponents, who live out their fantasies without worrying about the impacts they have on those they lead | Proponents are former or wannabe jocks |
The internal justifications for reorganizing identified in our mega-analysis include:
- You need to hide the fact that an organization has no reason to continue to exist
- It has been 3 years since your last reorganization
- A video conferencing system has just been purchased out of your employees’ retirement fund
- Your CEO’s brother is an organizational consultant
- The auditor general’s report on your organization is about to be released
The external justifications for pushing for a reorganization of someone else’s organization include:
- You are threatened by their organization
- You discover that their organization is functioning effectively
- You would like to direct attention away from your own organization’s activities
These justifications must never be made public. The fundamental rule is: ‘Never let on why—really—you are reorganizing’.
Leading in vicious circles of
redisorganization
New leaders typically take up their posts
intoxicated with the prospect of transformation
and radical revision. This triggers an
avalanche of constant and hectic activity.
Repeated redisorganizations(d) result in
exhausted managers who rush from one
meeting to another with no time to step back
and reflect. By the time the organization
decides to saddle somebody with the blame
for the resulting chaos, the leader has left to
foul up some other organization. The end
result is a perpetual cycle of redisorganization.
While all new leaders feel compelled to
redisorganize, it is nonetheless possible to
distinguish among several breeds of leaders
based on their canine redisorganization
behaviour:
- Mutts The most common type of leader: self-focused, with a need to piss all over everything to mark territory
- Bulldogs Well meaning, but incompetent, and dangerous when aroused
- German Shepherds Bureaucratic, commonly suffer from anal retentiveness, which makes them irritable
- Poodles Ideological, focused on a specific peculiar aim derived from a specific peculiar way of looking at the world, to the exclusion of empirical evidence, practical experience and common sense.
These four breeds display, to varying
degrees, the eight ‘secrets of success’: meet a
lot, sniff a lot (yes, they can smell fear), talk a
lot, listen infrequently, change a lot, delegate
(particularly responsibility without authority),
disappear and move on. These ‘secrets’
seem to be in the genetic make-up of the
common breeds of leaders since there is high
concordance in monozygotic twins.
Two behaviours are common to all of these
breeds. The first is a preoccupation with
SWOT (Scandalously Wasted Opportunities
and Time) analyses. The second is a natural
talent for self-promotion. Leaders belonging
to these breeds are masters of self-citation
(exaggerating their credentials), and adept at‘spinning’ negative feedback into testimonials
(such as ‘We were never the
same again’). Their reputations
resemble creative fiction more than
genuine accomplishment. According
to Tom Chalmers, by the time people
have earned their reputations they do
not deserve them (personal communication).
Common breeds of leaders
are good at moving on before their
reputations can catch up with them.
Two other breeds of leaders are
now so rare that it is not possible to
characterize them in any detail:
golden retrievers (inspiring) and saint
bernards (facilitative).
Indicators of successful
redisorganization
We found many useful indicators of a
successful redisorganization, including:
- All the good people have left, or become catatonic
- Inept people have been given tenure, or its equivalent
- Important decisions have been postponed, or are being made on a whim-to-whim basis
- Resolutions are being mistaken for solutions
- The number of administrators has more than doubled
- In healthcare redisorganizations, vast resources have been diverted from patient care, research and education and spent on relocating and refurnishing executives’ offices and supplying them with the flashiest business machines
- Administrators’ office windows point toward, not away from, nearby mountains, lakes, and oceans. Large consultancy fees have been paid to relatives by blood or marriage (hence HARLOT’s recruitment programme).
The generation of these indicators can niftily be summarized as the ABCD of any successful redisorganization:
- A minimum amount of thought has gone into a maximum amount of change
- Brownian motion has been mistaken for progress
- Coincidence has been mistaken for cause
- Decibels have been mistaken for leadership
IMPLICATIONS FOR PRACTICE
We have discerned four key lessons from our mega-analysis of redisorganization:
- For leaders and consultants who feed on cyclical redisorganizations: Be loyal to organizations always, and to people never
- For victims of redisorganizing leaders and consultants: Remember that the best-laid plans of mice and managers can be disrupted by creative imagination. Exploit the chaos for more worthy goals
- For those in well-functioning enterprises who want to avoid being redisorganized: Fake it. Make it look like you are redisorganizing already: Schedule (but don’t hold) countless meetings; plagiarize, photocopy and distribute (on coloured paper) strategic plans lifted from out-of-town victims; rename traditional sporting and social events ‘teambuilding’; and get on with doing your job
- For perpetrators of perpetual redisorganizations: Why don’t you just go . . . reorganize yourselves.
IMPLICATIONS FOR RESEARCH
The requirement for ethics approval of
anything labelled ‘research’ spells trouble
for advocates of redisorganization. If they
are going to continue to label as ‘research’
the anecdotes that pass for incontrovertible
evidence in this area they are going to need
ethics approval for the uncontrolled,
unplanned experimentation that they inflict
on organizations, including the health services
and users of the health services (i.e.
all of us). The alternative is to admit that
the emperor has no clothes and that they
are just messing around with us. To get
around this, we at HARLOT are establishing
special ethics committees, which, for a
price, will review the ethics of plans for
redisorganizations.
The answers to five simple questions
will determine whether we approve any
redisorganization proposal. The first
three questions must be answered NO,
and the last two YES:
- Is it possible for the new leader proposing the redisorganization to get his/her jollies in some other way?
- Is it possible for the organizational consultants to earn an honest living?
- Does the organogram used to illustrate the new organization have fewer than 22 boxes and 45 connecting arrows?
- Is the organizational theory justifying the redisorganization lifted from a paperback best seller, written by a guru with good anecdotes and catchy phrases, and available in airport bookshops?
- Will HARLOT get a piece of the action?
Redisorganization proposers who initially fail this review are invited to resubmit. If they are smart, they will then avail themselves of HARLOT’s ‘redisorganization-in-a-box’ recovery service. Mind you, if they had been really smart, they would have come to us in the first place.
CONTRIBUTIONS
ADO, IC, and DLS conceived the idea during a pleasant afternoon stroll on Port Meadow, in Oxford. DLS, IC and ADO went to the concert while TEP was working. All four authors enjoyed the fun of iterative redisorganizations of the manuscript. SA was invited to illustrate the article, but politely declined.
Competing interests Lots.
REFERENCES
a) Sackett DL, Oxman AD. HARLOT, plc. An
amalgamation of the world’s two oldest professions.
A new niche company specializing
in How to Achieve positive Results without
actually Lying to Overcome the Truth. BMJ
2003;327:1442–5
b) Oxman AD, Flottorp S, Fretheim A. The
OFF theory of research utilization. J Clin
Epidemiol 2005;58:117–18
c) Anonymous. The advice business. The
Economist 22 March 1997
d) Smith J, Walshe K, Hunter DJ. The‘‘redisorganisation’’ of the NHS.
————————
Extract from the Journal of the Royal society of
medicine, Volume 98, December 2005.
Reproduced by permission.
© 2006 UN Special |