1. Hierarchy and Leadership Dr. Curtis Smecher VP, Quality and Patient Safety BC Anesthesiologists Society

2. Important Distinctions Leadership Culture Organizational Structure

3. Administration, Management and Leadership are not the same thing Ackoff’s F/law #38 Administration is the direction of others: In the pursuit of ends and By the use of means Both selected by others

4. Administration, Management and Leadership are not the same thing Ackoff’s F/law #38 Management is the direction of others: In the pursuit of ends and By the use of means Both selected by the Manager

5. Administration, Management and Leadership are not the same thing Ackoff’s F/law #38 Leadership is the direction of others: In the pursuit of ends and By the use of means Collectively selected by those involved

6. Administrators and Managers are over abundant and are usually found LURKING in Hierarchical Structures Leaders are in short supply

7. Maccoby’s 3 Modes of Production 1.Craftsman 2.Bureaucratic 3.Knowledge/Interactive

8. Maccoby’s 3 Modes of Production 1.Craftsman Doctors! Everyone does it differently We have our Apprentices (Residents) We are organized in Guilds (BCMA, CPSBC) We work mostly solo, and Fiercely defend our independence

9. Maccoby’s 3 Modes of Production 1.Craftsman 2.Bureaucratic Since the Industrial Revolution Top Down, Command and Control Favors Taylors “Scientific Management” techniques These 2 cultures constantly collide in our workplaces

10. Maccoby’s 3 Modes of Production 1.Craftsman 2.Bureaucratic 3.Knowledge/Interactive Born in the current age of the internet Structure is fluid and adaptable Consensus plays a large role Loyalty to social groups but little to Organizations Flatter structures This is where we need to be.

11. Organizational Structure Any complex problem needs to be broken down A Hierarchy is an efficient and effective Organizational model Hierarchical structure is NOT Synonymous with: Bureaucratic Culture Command and Control Styles Hierarchies order a problem into: Managable Chunks, and A coordinating structure

12. Conclusion Hierarchies can be an effective and efficient way to organize complex problems What kills creativity is not Hierarchies, but the way Hierarchies are used in: Bureaucratic Organizations Administrative and Management direction styles We need True Leadership in a Knowledge/Interactive production mode addressing complex problems appropriately organized.

13. Don’t throw out the baby with the bathwater

14. Hierarchies, with good leadership, are NEEDED in order to address large and difficult problems