A surrealistic mega-analysis of redisorganization theories

J R Soc Med 2005;98:563-568
doi:10.1258/jrsm.98.12.563
© 2005 Royal Society of Medicine
J R Soc Med 2005;98:563-568
© 2005 The Royal Society of Medicine


A surrealistic mega-analysis of redisorganization theories


Andrew D Oxman1
David L Sackett2
Iain Chalmers3  
Trine E Prescott4


1 Researcher, Norwegian Centre for Health Services Research, Oslo, Norway
2 Director, Trout Research and Education Center, Markdale, Ontario, Canada
3 Editor, James Lind Library, Oxford, UK
4 Physician, Medical Genetics, Rikshospitalet University Hospital, Oslo,
Norway

Correspondence to: Andy Oxman, Norwegian Centre for Health Services Research
Pb 7004, St Olavs Plass, 0130 Oslo, Norway
E-mail:
[email protected]



   
SUMMARY

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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

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HARLOT1 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, best-evidence 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

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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

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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’.2
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.



View this table:
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Table 1. Organizational theories and their diagnostic signs

 



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Figure 1. HARLOT plc Organogram. Organograms rarely have fewer than 22 boxes
and can have as many as 1012. As a rule they should have a minimum of 2n+1
lines connecting the boxes (where n=the number of boxes). The organogram
employed in generating this paper is shown 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 2000.3 Of
course, nobody seems to know 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 CostDirthouse) 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.3

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 cost-centres in the hotel, restaurant and travel
industries.

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
redisorganizations4
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

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We have discerned four key lessons from our mega-analysis of
redisorganization:

  1. For leaders and consultants who feed on cyclical redisorganizations: Be
    loyal to organizations always, and to people never
  2. 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
  3. 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
    ‘team-building’; and get on with doing your job
  4. For perpetrators of perpetual redisorganizations: Why don’t you just go…
    reorganize yourselves.



   
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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:

  1. Is it possible for the new leader proposing the redisorganization to get
    his/her jollies in some other way?
  2. Is it possible for the organizational consultants to earn an honest
    living?
  3. Does the organogram used to illustrate the new organization have fewer than
    22 boxes and 45 connecting arrows?
  4. 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?
  5. 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

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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.



   
Footnotes

 

Competing interests Lots.



   
REFERENCES

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 REFERENCES

 

  1. 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.
    BMJ2003; 327:1442
    -5[Free Full Text]

  2. Oxman AD, Flottorp S, Fretheim A. The OFF theory of research
    utilization. J Clin Epidemiol2005; 58:117
    -18[CrossRef]

  3. Anonymous. The advice business. The
    Economist
    22 March 1997

  4. Smith J, Walshe K, Hunter DJ. The “redisorganisation”
    of the NHS. BMJ2001; 323:1262
    -3[Free Full Text]

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