Control does not scale.

The definition of a traditional hierarchical organization includes the hospital as an example.  That’s a problem because our society has entered a new age.  The world is messy and getting messier.  Extolling the good is becoming more difficult.  Jeff Jarvis:

So now, we’re digitizing and connecting in an age of abundance. There’s an abundance of good and of crap but, he says, we’re much better at dealing with the abundance of crap. Yes, we filter it, kill it. David [Weinberger] says that when there’s an abundance of good, our institutions are not built for it. “Control does not scale,” he says, “except at tremendous human costs.” Damn, he’s good at setting down the clear law. Control does not scale. Next: “The mess is essential.” The mess is the better reflection of who we are.

Hospitals, in the effort to rid the environment of messiness, control.  They control messages, processes, people, patients, service, etc.  But as Mr. Weinberger so efficiently proclaims, “Control does not scale.”  Hospitals today are not built for the wild environment in which they have begun to operate.  That means a tough road ahead.  Because control as a business model is eroding quickly.  The response, of course, will be more intense efforts to control.  The transition to a completely open model is something that most hospitals are not equipped to handle: in systems, management, and practices.

Who is good at the open model?  Google.  Granted the company was founded on open principles but there are lessons to be gleaned from their operation.  Jeff Jarvis and his new book “What Would Google Do” to the rescue (it was released this week and could become the bible from which to learn from).  An excerpt from the book’s first chapter:

That world is upside-down, inside-out, counterintuitive, and confusing. Who could have imagined that a free classified service could have had a profound and permanent effect on the entire newspaper industry, that kids with cameras and internet connections could gather larger audiences than cable networks could, that loners with keyboards could bring down politicians and companies, and that dropouts could build companies worth billions? They didn’t do it by breaking rules. They operate by new rules of a new age, among them:

  • Customers are now in charge. They can be heard around the globe and have an impact on huge institutions in an instant.
  • People can find each other anywhere and coalesce around you—or against you.
  • The mass market is dead, replaced by the mass of niches.
  • “Markets are conversations,” decreed The Cluetrain Manifesto, the seminal work of the internet age, in 2000. That means the key skill in any organization today is no longer marketing but conversing.
  • We have shifted from an economy based on scarcity to one based on abundance. The control of products or distribution will no longer guarantee a premium and a profit.
  • Enabling customers to collaborate with you—in creating, distributing, marketing, and supporting products—is what creates a premium in today’s market.
  • The most successful enterprises today are networks—which extract as little value as possible so they can grow as big as possible—and the platforms on which those networks are built.
  • Owning pipelines, people, products, or even intellectual property is no longer the key to success. Openness is.

The mess is essential.  Openness, too.

Extricate, Communicate, Innovate

Think of the possibilities if we could do this within a hospital:

Imagine a global corporation – maybe a software company or an accounting-consulting firm – in which people at all levels and positions could interconnect and network together, and then solve problems together. A company with an internal intranet containing an internal Facebook, blogs, work logs, etc. fully searchable by anyone else in the company. Perhaps employees anywhere in the world could connect in any way they needed to: video conference instantly from their laptops, or leave video messages for each other.

If all the talent in the company could connect easily, that could bring enormous innovation acceleration. Problem solving could be far more efficient. Maybe David in the office in Singapore has already solved a problem now facing new person Carly in the office in Boston? What if Carly could type in a few key words and learn that David dealt with the same issues last month?

While I’ve heard of companies trying to better connect their workforces through intranet applications, I haven’t heard of too many turning all or most of the process over to all employees, especially the younger generation (but please comment and tell me who is doing this if you know).

The first company that achieves this extreme interconnectivity would instantly have tremendous leverage against competitors from an enormous boost in productivity and innovation.

Connect:  Extricate!  Communicate!  Innovate!

Encourage employees to solve problems by connecting and empowering them.  Remove traditional barriers (I work on the 7th floor, I work in Radiology, I’m a nurse) and allow innovation from below: give employees the tools to communicate with each other and access to actionable data.  This challenging time is not one in which to exert more control; for it will be the free organization that will prosper.