We have become very good at management – so good that we have set it (and ourselves) on a pedestal. But management is not a panacea. We throw it at every problem,
Two of the most pressing problems facing us today are health care and education. The cost of the former is out of control. The quality of the latter is declining and testing isn't fixing it.
The reason is straightforward: health care and education require a relationship between individuals – one person helping another. True, there is more to it than that – but the basic requirement remains. Ask anyone whose life was changed by a good teacher.
I am a huge fan of Dr. Atul Gawande. He writes like a dream, takes me into his world of medicine and surgery, and seriously addresses the problems facing his profession. But his most recent article Big Med (the New Yorker, August 13) took me into new territory. He describes how hospitals (including his own) are forming into conglomerates, and compares the management of these conglomerates with that of The Cheesecake Factory, a large and successful restaurant chain.
I devoured the article with my usual fascination and perhaps a touch of trepidation. The next day, I brought it up with one of my sons, who had also read it. He had been horrified, he said, both by the idea that health care could be “managed” like a restaurant chain, and by the “creepy” remote monitoring (by closed-circuit TV) of doctors on the job.
We had a lively discussion. In hindsight I can see my son brought me around to his point of view.
For the last decade the Organization for Economic Cooperation and Development (OECD) has been ranking countries in educational achievement using PISA tests. (Program for International Student Assessment). Finland has consistently ranked at or near the top. What is its secret? Respect for teachers.
The Finnish position on education is the opposite of the North American (especially the U.S.) position. There are tests, but they are not standardized. Teachers make and give tests to see if the student has learned and if they themselves have taught. Teaching is a higher-prestige occupation than medicine or the law. Teachers must have a degree, but it is not in education. The degree itself (at least an M.A. with a thesis) is the license to teach. When asked what might make them leave the profession for, say, business, Finnish teachers cite not higher pay, but loss of autonomy.
Management or Collegiality?
As recently as a generation ago, doctors and teachers could and did operate alone: the private practice and the one-room schoolhouse. Since then huge advances in technology have made that impossible. So much knowledge is available today that health outcomes are compromised if the patient's medical history is not instantly available to the specialist. Learning is limited if the teacher cannot back up her teaching with the Khan Academy and Coursera and learn from these herself. As Dr. Gawande points out, doctors (and teachers) must continue to learn from each other.
All this argues for collegiality. Good management can make sure fresh food isn't wasted at The Cheesecake Factory and it probably has a role running schools and hospitals. But as Finland's example shows, it is counterproductive when used to control doctors and teachers.
Why is this so? And why now, more than even a decade ago?
Financialization. The word is not in the dictionary, at least not yet. But there it is in Nicholas Lemann's Transaction Man, the excellent and revealing article about Mitt Romney's background in the October 1, 2012 issue of The New Yorker. With financialization – financial “products”, hedge funds, and private equity – management has been taken to a new level where, effectively, only money matters.
Of course, money is called productivity and efficiency among other euphemisms. But what it means in practice is that human interaction, energy, and invention are now virtual qualities at best, and at worst ignored altogether. Is it any wonder that in North America and especially in the U.S.A. health care and education have the highest costs in the world and some of the worst outcomes?
George Romney told his son, who idolizes him, that “there's nothing as vulnerable as entrenched success.” During Wednesday night's debate Mitt himself said his goal was to maximize the potential of each individual. How ironic is it that the son's policies and politics – the real policies, not the slight-of-hand wordplay visible Wednesday night – are systematically dismantling his cherished management and stifling each individual's God-given gifts, effectively fulfilling his father's prophecy?
Mitt Romney may, in his heart of hearts, believe in the sacred gifts of each human being, and even in the absolute necessity of their being channelled into paths that benefit society as a whole. It is, alas, probably too late for him to see how his actions are undermining his belief. That is for us to see and correct.