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Top-Down vs Bottom-Up Management

Hello everyone,

I'll start by saying that I'm not a huge fan of top-down management. I'll give 2 examples:

Coronavirus book

The direction of the main hospital where I work made a book about the coronavirus period with pictures of employees and patients. It's a book that cost about 13-15 euros/dollar. They gave it to the 12'000 employees, which totals approx. 154'000 euros/dollars. So far so good.

The problem is that during Covid, employees were moved from one unit to the other without asking for their agreement. This is understandable in times of crisis of course. However, this was on top of bad management, already stressed out and dissatisfied employees. Basically, no respect and no recognition.

On top of it, there was a Covid "bonus" for many employees at the end of the crisis. The amount was around 1000 euros/dollars per employee. I got such a bonus. The problem is that I got it despite not having had to move to other units (like intensive care) nor having to have done tons of overwork (pediatrics was not really affected by the Covid crisis).

Many people who were way more involved than me did not get the bonus. And the whole hospital management is quite bad for my standards (complicated procedures to get anything done, changes are really really slow and come from the top only, too much politicking, very hierarchical, not much respect/recognition, bad schedules for most people, etc.).

So there was an interview of the nurses union on Swiss TV about this book. Basically they said: "we're exhausted and ask for more personnel since years and years and did not get anything, and now we get a luxurious book? This is making fools out of us"

So what do the nurses do? (they're quite solidary)

They give the book back by thousands. It's an unrequested and inappropriate gift to them. And I agree.

So it's again a "nice project" from the top: "these people want recognition, we're going to give them a nice book with pictures of them in it, they're going to love it and show off to their families".

Well, as I said to my nurse colleague: "this book is a bad message indeed".

"It's a nice project"

I had a meeting with higher-up office people from the hospital management (the main one, 12'000 employees, not the small one 200 employees, which is a subunit of the large one).

The meeting was about the organization of a consultation at the small hospital. It's a consultation where we see the whole families during a morning at once: the parents with adult doctor in parallel with the children with pediatricians (my role).

My boss wanted me to be there because I'm on the field and I saw the problem. In short this consultation is badly organized and it makes it tiring and complicated for us and especially parents and children. Lots of in-and-out movement of the examination rooms, 3-4 hours of questions to the parents (them then the children), cancellation of consultations from the adult medicine without informing us, etc.

The good thing is that we could talk openly about the problem. I learned that the money for this consultation was coming directly from the Swiss government. As I'm sure you're aware during these meetings, it's a lot about where the money is coming from, how to get money, etc. It's the job of the higher-up in offices.

At some point, the "assistant" of the director of adult medicine, a power-aware woman who introduced herself as "Barbara, assistant of Prof. X of this department". So she started the whole authority thing right off the bat, instead of explaining her exact role: "I'm in charge of the budget of this" or something else.

And at some point, she said about this whole mess (it's been going like this for 2 years, no meetings to correct things): "It's a nice project".

Well, yes it's a nice project. But if you don't get feed-back from the field, then it's nice on paper only and shit in reality.

This is to show that people in offices make projects and they can tell their co-workers, bosses and friends: "We have this beautiful project for migrant children, we see the whole family together so blablabla".

What my boss told me later privately is:

Him: John, I'm going to tell you a secret. The problem is that they don't do evaluation for these project

Conclusion

I'm sure this exist in any organization. They don't ask what is needed on the field and don't get feed-back once it's implemented. I think it's worse in public organization and in highly political organization.

My organization is highly political and public. So it's bound to happen as people at the top might be ok, but not highly competent. They're very good at politics to climb up but not so much at their actual job. I'm talking especially about office people (the communications lady who writes worse than I do and it's not even my job). I guess it's because there is less visibility in these kind of jobs of the quality of your job. I don't exactly know the reason.

I'm happy to hear your opinion about this topic.

Caveat: As per recent talks and for the sake of good communication: this is not black or white (one is good, the other is bad). It's about discussing the flaws of top-down organization and the solutions to it. Also, there is no 100% top-down nor 100% bottom-up of course. By "office people", I mean people whose jobs are of mainly or solely of administrative nature (management, etc.). This includes doctors and nurses with administrative and managerial functions as well (head nurse, head physicians, etc.). For instance, the head of the hospital is a physician who approved the Coronavirus book project.

I feel your pain, John.

Embedded conflict of interest

I am deep in the mud of academic life (bottom rung) and the environment is very similar. Unfortunately there is conflict of interests between higher-ups and the people/employees they manage. Of course they are going to prioritize efforts that make them appear/feel good than actually doing the right thing. In a culture that the people who have less power are not heard, it is easy to be misdirected. Worse, they are incentivized not to listen, and because of limited resources they easily see people below them who complain as a burden or "sore losers".

On effectiveness

On the flip side (from the management point of view), it is about social efficiency, since sometimes it is more efficient to not listen while decisions need to be made quickly. In the modern environment, I feel rarely there is a life/death issue that needs to be done in a pure top-down approach, other than emergencies as well as in the military setting - yes drill sergeants are useful in some occasions.

Checks and balances

I am pretty pessimistic in that unless there is high risk that their "cake" is going to be destroyed, higher-ups would not listen. That's why we have checks and balances in many systems, although they are usually not great and small travesties are usually ignored/forgotten. On a higher level, that's why we strive for social equity and justice.

 

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John Freeman
Quote from Emily on September 9, 2022, 10:33 pm

I feel your pain, John.

I'm not in pain but thanks for the kind words anyway! I'm baffled by the selfishness, stupidity and ego which lead to these absurdities. Poor character, poor introspection, poor commitment to the mission. So poor leadership overall.

Embedded conflict of interest

I am deep in the mud of academic life (bottom rung) and the environment is very similar. Unfortunately there is conflict of interests between higher-ups and the people/employees they manage. Of course they are going to prioritize efforts that make them appear/feel good than actually doing the right thing. In a culture that the people who have less power are not heard, it is easy to be misdirected. Worse, they are incentivized not to listen, and because of limited resources they easily see people below them who complain as a burden or "sore losers".

Yes, it's all about what is rewarded and punished. What behaviour gets reinforced or extinguished.

On effectiveness

On the flip side (from the management point of view), it is about social efficiency, since sometimes it is more efficient to not listen while decisions need to be made quickly. In the modern environment, I feel rarely there is a life/death issue that needs to be done in a pure top-down approach, other than emergencies as well as in the military setting - yes drill sergeants are useful in some occasions.

Yes, that's totally fine when warranted. However, the book situation is typically something where they could have been more sensitive and listen to the base. People can go through their whole career being bad managers as they might not be challenged at all. People will complain but they are in power so they sail the sea as if nothing happened. It does not make it right. Same with "it's a nice project", the failure of this project is a failure to get information from the base.

If we want to be social efficient in these two cases, the time taken to ask for feed-back would have prevented a lot of time wasted down the line.

They can behave like that because they're not at risk of being fired being hire-ups (Rare instance when they get fired. For instance there is this head physician who's a surgeon who's been found guilty of sexual harrassment. It was a long time before he was given a 6 months suspension (paid I'm sure). He came back, was found guilty AGAIN of harassment (don't know the nature) and this time got fired. It took years of this behaviour for this to happen. People down the food chain cannot afford (and rightly so!) these kind of behaviours without being laid off right away.

Checks and balances

I am pretty pessimistic in that unless there is high risk that their "cake" is going to be destroyed, higher-ups would not listen. That's why we have checks and balances in many systems, although they are usually not great and small travesties are usually ignored/forgotten. On a higher level, that's why we strive for social equity and justice.

Exactly, it's about the system of checking people's behaviours. And it's true it's only when they fucked up so bad that they're in trouble that they listen. That is how we created our group of resident physicians: in time of major crisis for the institution. Otherwise, the status quo would have prevailed.

So there is definitely a timing element,

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Lucio Buffalmano

I often think of top Mgmt as like the last years of Versailles.  It's an echo chamber based around playing to the king.

I think your residents group is a fantastic initiative.  As it's providing access to the voice of the people to the higher ups.  So to me having vertical and cross functional forums is a great way to sanity check the dumbest projects before they start running down the hill, wheels on fire.

I used to think servant leadership would win the day.  But unfortunately I think that is only possible in operational management roles.

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Lucio BuffalmanoJohn Freeman

I used to think servant leadership would win the day.  But unfortunately I think that is only possible in operational management roles.

Hey man, good stuff!

Could you please elaborate on this?

My greetings from the other side of the Earth 🙂

To me it comes down to objective measures and being close to the work.   Some good work has been done on OKRs but in most organisations once you go up the layers its not a contest of ideas but a contest of alliances.  The classic example is where somebody's mate gets the job or the purchase contract.  That's where I think having cross functional and vertical forums can help because you have more eyes and more churn of people.  So less chance of the leeches finding a nice vein and just staying there forever getting fat.

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John Freeman
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