What ails the public health systems

The eminent management guru, Gareth Morgan, used metaphors in a very imaginative and creative way to describe organizational structure and functioning. Machine, brain, culture, domination, psychic prison, organism, political system and flux and transformation metaphors were used emphatically to associate certain features with each one of them. Planning, protection and prestige were the topics covered in the mechanistic way of interpretation of organizations. Complex judgements and survival were incorporated into the adaptive organism model. Psychic prison dealt with resources and survival; whereas protection, autonomy, prestige, resources and survival seen in the political system were explained by using that metaphor. The drawback of using these metaphors to explain organization is that all these are mutually inclusive. One should not see them as distinct and separate from one another and it would be fallacious to solely depend on one metaphor as seeing through one metaphor distorts the view and doesn’t allow other metaphors strengths to be analyzed.
Organization as machine:
The sub units of a machine function well within their limits and perform in perfect synchrony to achieve the desired result. Their predictability and precision are their main strengths. Drawing an analogy from these perfect systems, Morgan proposed this metaphor to describe the functioning of an organization. The core value of this model lies in the rigid hierarchy that takes precedence even above that of the organization’s goals. Drawing strength from historically and time tested military techniques, the sociologist Taylor set out manpower training, monitoring of staff, right person in the right place, and shift of planning responsibilities to managers as principles that governed and even shaped some of the most successful business principles of our modern times. Sadly, though very effective, the human element was neglected and never looked upon seriously. The compartmentalization of job skills, delegation of implementation to ground staff, non involvement of staff in day to day planning has all but removed the pride and prestige associated with the work. The irony is that this model is very effective in situations that require a simple straightforward task to be performed especially when one wishes to produce exactly the same product time and again from batch to batch, when precision is required at all times, and when the human "machine" parts are compliant and behave as they have been instructed to do. Applying robotic models works even better when environment is all the more conducive. Precision, speed, clarity, regularity, reliability, and efficiency achieved through the creation of a fixed division of labour, are the key strengths of mechanistic model.
What is lost in the bargain is the creativity, individual sense of responsibility, pride in the job, resourcefulness to overcome problems that might arise during task completion, innovative spark, adaptability, flexibility and a host of the all important functions that humans capably do when presented with obstacles or stress. In short, adaptive response is absolutely and irrefutably corrupted by mechanization in work place. Telling someone to do a job is one thing, but giving him a list of things he can do and can’t do ebbs away the “feel good” factor that he associates with his place in his organization. Doing the same thing over and over again drains away the joy of his/her livelihood. Carelessness, apathy passivity, negative recidivism do not take long to creep in. “Fitting in” people as slot coins only worsens the situation as you do not allow them to blend and grow within the system. Mindless pursuits, inter/intra departmental lack of cooperation then take center stage to distort and contort the information in/outflow. The system is then trapped and takes a long time to regain it’s foothold when confronted with a new situation. The mechanistic approach to organizations tends to limit rather than mobilize the development of human capacities and changes the perception of the work force of the environment as hostile and unsupportive/uncooperative. It is difficult to achieve effective responses when there is a high degree of specialization. This may create the kind of powerlessness where each element's actions ends up working against the interests of everybody. Hierarchical supervision, and detailed rules and regulations may make an efficient unit, but, never a harmonious one.
Suitable metaphor for public health:
Public health in recent times has blended itself into political, scientific, policy, health and management issues so much so that it is now a major field by itself. Active inputs come into it’s system from all the aforementioned fields. For such a mammoth scale organization a mechanistic model will simply not do. The human element is what makes public health an endearing subject. We deal with communities and application of preventive measures for the betterment of health among people. In a polarizing world ruled by ” haves”, the have - nots will suffer the most if we apply the mechanization concept. If the right to plan and implement is solely vested in the powers that be with a rigid set of hierarchical domination, public health will be in doldrums. It needs constant feedback from the community as it is a ever evolving field. Disasters and emergencies need effective and quick responses that adapt themselves to the situation at hand. Public health professionals need to learn from complex and challenging situation and respond with a better measure when confronted with the same in future. It is a learning experience that needs planning, implementation and pain staking work at grass root levels all done at the same time by the same people. Bureaucratic methods such as planning by the men in ivory towers, implementation by middlemen and work by community is simply not the way public health works. The pulse of the public –at- large has to be felt by health care professionals. Staff care and morale in the public health sector have to be on a very high scale to improve the commitment levels. A blend of organism, flex and transformation models will suit public health much better than mechanization.
In conclusion, Public health has to balance equity and resources on one hand, and, at the same time has to plan, perform complex judgmental decisions that require a fresh mind set bereft of old hegemonies. Conducive environment has to be established for it’s work force to outdo their past successes and learn from their past mistakes. Flexibility and creativity are it’s main pillars, and if we are to respond effectively in emergencies, a model that incorporates and emphasizes cooperation, open communication channels and smooth coordination needs to be applied. Mechanistic dehumanized model will make it a very inefficient organization that stumbles at the very beginning of a task.