Joined-Up Thinking and the "Germ Theory of Management"

caterpillar turning into butterfly

If I hear another commentator, while bemoaning the ills of our country (any country but in my case Ireland), say that "what we need is some joined-up thinking" and say it as if it's some "as-yet-to-be-found" sub-atomic particle, or is buried under an Arctic icecap and remains unreachable, then I am afraid I am likely to scream.

As long ago as 1986 ( and probably many years before that), Edward Deming, who was one of a small number of people who helped Japan leap to the top of the of the world’s league table of industrial powerhouses, wrote in his "Out of Crisis" book that "Employees work in the system" and "Management’s job is to work on (and improve) the system".

Joined-up thinking is the colloquial name given to the management and improvement of systems, a subset if which are processes, and this is the role of management. (Technically it is true that people working in a system can and should improve "the system" but their sphere of influence is severely limited unless management lead by example and commitment. Hence the extreme frustration of those caught in "the system" who are screaming out for some joined-up thinking only to find that so are their managers! ).

The science/discipline that underpins joined-up thinking is called Systems Thinking/Systems Dynamics/Business Dynamics, all of which are or should be embodied in the management disciplines of Operational Excellence or Total Quality Management (TQM).

Lean Operations/Thinking (focus on waste), Six Sigma (focus on variation), Theory of Constraints (focus on bottlenecks) and other such specialisms are part of the broader TQM/Operational Excellence discipline(s) which every practising manager should be expert in or at least sufficiently competent.

The unfortunate truth is that, like some "lost gene-pool", many of the skills that have evolved in the "operational disciplines" have failed to successfully make the evolutionary leap from the manufacturing/industrial sectors and adapt to the needs of the service and knowledge worker sectors.

In his paper "The Germ Theory of Management" Myron Tribus wrote:

"In a recent review of the Deming Theory of Management, William Gartner and James Naughton wrote:

"Medicine had been 'successfully" practised without the knowledge of germs. In a pre-germ theory paradigm, some patients got better, some got worse and some stayed the same; in each case, some rationale could be used to explain the outcome."

Doctors administer to the needs of their patients according to what they learn in school and in their training. They also learn by experience. They can only apply what they know and believe. They have no choice. They cannot apply what they do not know or what they disbelieve. What they do is always interpreted in terms of what they understand is "the way things work". As professionals they find it difficult to stray too far from the common knowledge and understanding of their profession.

They are under pressure to follow "accepted practice".

In this regard, Doctors are no better and no worse than the rest of us (managers) . We are all prisoners of our upbringing, our culture and the state of knowledge of our teachers, mentors and fellow practitioners.

Today we smile when we read that after sewing up a wound with silken thread, the surgeons of 150 years ago recommended to leave a length of the thread outside the wound. This was done to draw off the pus that was sure to follow the insertion of unsterilized thread by unwashed hands using an unsterilized needle.

Changing People's Beliefs Is Not Easy

Try to imagine that it is now the year 1869. Pasteur has only recently demonstrated that fermentation is caused by organisms which are carried in the air. Only a few months ago Lister tried out the first antiseptic, carbolic acid, and found that it worked to prevent inflammation and pus after surgery. 120 years ago the spread of medical information was much slower than today.

Imagine you are a young researcher in a medical school in the USA. The Civil War is over and you are trying to develop your own career after army service. You are a serious young doctor who tries to learn the latest developments in the medical profession.

Suppose that you have just read about Pasteur's and Lister's work and that you have been invited to speak before a group of distinguished physicians, many of them having come to fame for their heroic service as surgeons during the American Civil war.

What you now understand from your readings is that these famous physicians are actually killing their patients.

Your responsibility is to explain to them, if you can, that because they do not wash their hands or sterilize their instruments, they sew death into every wound.

Your assignment is to persuade them to forget most of what they have been taught, to abandon much of the wisdom they have accumulated over their distinguished careers and to rebuild their understanding of the practice of medicine around the new theory of germs.

Do you think you could do it? Do you think you could convince them? Do you believe they will they be glad to hear you? .........

...........What do you think will happen to your practice if this kind of word gets bandied about? How would you be likely to greet the messenger?

Just like Pasteur's germs, variability is everywhere. It cannot be seen with the naked eye. The virus of variability can only be detected by using special instruments. Germs are controlled by pasteurization. (Walter) Shewhart showed how to measure the virus of variability, how to reduce it and how to keep it under control. In short, Shewhart invented the equivalent of pasteurization (for processes)

In the beginning people thought that Shewhart's approach was only suited to the manufacture of devices. Just as Lister understood the broader significance of Pasteur's work to the practice of medicine, so too did Dr. W. Edwards Deming understand the significance of Shewhart's work to general management.....

------These men realized that the key to better management is the study of the processes whereby things get done and through such study to learn how to reduce its variability and to obtain predictable results from all processes, even intellectual processes such as designing, planning and budgeting.

(These) investigations thus laid the foundations for the "germ theory of management"."

The full paper (and more) is available at:

The fundamental reason why doctors didn't understand germ theory was that they didn't understand "the system", i.e., the human body.

Similarly, managers who don't understand organisational and inter-organisational systems are likely to be "hacking off limbs" to save patients when in fact they are often the cause of spreading the deadly viruses causing the problems.

To continue with the medical analogy, if all managers understood the organisation as a system and were broadly competent in all the core disciples of management, in the same way that medical doctors need to understand the workings of the human system and are broadly competent in the core disciplines of medical practice, then it’s likely that our successes in medical advancement would be paralleled in our organisational advancement.

An Unfortunate Irony

It’s an unfortunate irony however that the medical profession, who have evolved an unfathomable depth of understanding as to the workings of the human system and consequently have made huge leaps in their own domain, remain blind for the need to apply the same principles to managing the health system.

No competent medical practitioner would ask a lay person (if I can use that term) to perform a medical procedure of any consequence except perhaps in an emergency and/or only under the supervision of a qualified medical practitioner.

However medical practitioners ( or indeed many other professions) have no qualms in assuming that they can and should run/manage/re engineer/transform complex organisations such as hospitals or health services without any training or expertise in the disciplines that underpin effective and efficiently managed organisations, never mind high performing organisations.

Until such time as the subject matter experts in the service and knowledge worker sectors come to value the full suite of management disciplines, including Operational Excellence/TQM/Lean, and either embrace them for themselves or embrace their application by their (qualified) Operations Management peers, then we are condemned to suffering the torment of working in or being serviced by organisation who are managerially stuck in the 18th century, where managers unknowingly spread and propagate the diseases inherent in legacy management practices, which in turn create the endless opportunities in the BPI/Performance Improvement/Transformation fields for practitioners like

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