Managing the unmanageable and feeding the beast

Working on national NHS IT projects, it often feels like any progress is achieved in the face of the active opposition of the organisation we work for (currently NHS England). It's like the organisational bureaucracy in its wider sense (ie including the government department, DHSC, Treasury etc) has been designed with the express intention of preventing us making progress without enormous reserves of dogged persistence. We're in a war of attrition with a constantly shape-shifting bureaucracy.

This might not be a silly as it sounds. Many of the initiatives we work on may not have been formally adopted or approved by the senior leaders in the organisation, or only in the most superficial way. These projects frequently come from government documents like the current '10 Year Plan' or its predecessors. Others 'leak' into the organisation through direct contact between DHSC policy teams or individual ministers and delivery teams.

We need to acknowledge that the delivery teams themselves often have a vested interest in encouraging this model: wanting to pursue projects because they believe it to be a good idea or in patient interests, but needing a powerful backer/champion/patron to support and enable their work.

This puts management in the difficult position of not being in full control of the organisation's workload and priorities and with responsibility for satisfying a diverse group of stakeholders, many with overambitious or unrealistic expectations.

To this we can add another layer of patronage: between the organisation's senior leaders and their ministerial or civil services seniors to whom they owe the continuation of their role.

In an idealised world, senior managers would develop their own agenda and priorities, filtering all the demands, then harnessing the organisation's resources to deliver these. Simultaneously, they would manage expectations upwards. That would involve taking responsibility for prioritisation decisions, deciding who needs to be disappointed and carefully managing those difficult conversations.

Back in the real world, we have bureaucracy; an endless thicket of process. In theory, this is to ensure public money is spent wisely and to reduce 'waste'. In practice this acts as a filter, weeding out or more usually delaying those projects that don't reach a threshold of importance, support or have a sufficiently dogged and determined team trying to progress them. 

This removes the necessity of senior managers making potentially unpopular decisions because the decision-making is a multi-faceted thing defused across numerous individuals and committees.  And if the bureaucracy prevents an important project from making progress, the responsible delivery team can then be blamed for not negotiating the processes effectively, or for not being sufficiently energetic and dedicated in pushing it forward.

Everyone is a winner.....

But the costs of this are not trivial.  The amount of time and effort required, the person hours required just to gain approval for work that has already theoretically been agreed creates a massive cost and time overhead for any and every project. And of course, as in physics, any filter impedes all progress to to some degree.

This is where the real 'waste' is.

Ultimately, many of us are just engaged in this process of 'feeding the beast' rather than actually doing productive work.