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Managers and staff in the health services face a very difficult operating environment.  Unlike the private sector, they are not in a position to close the door when demand exceeds the capacity of the service provided. The result is that performance on key indicators such as waiting lists and HCAIs, can be unsatisfactory. 

It is natural to look outside the organisation to see if there are better ways of operating.  Leading-edge, world class and best practice are the catch phrases attached to organisations which seem to be operating well above average in any particular sector. Management gurus, international consultancies and prominent academics convert the excellent practices of these organisations into commercial capital by proposing them as the next big idea. Many of these ideas are well such as MBO, Six Sigma and TQM.  However, how can we know whether the next big idea is capable of making a significant contribution or is simply a management fad?  

Fads become fashionable because they appeal to our hope that there is an easier way to be successful. Search Google for “Spotting Management Fads” and you will find a Harvard Business School article by Danny Miller and Jon Hartwick outlining research which they completed.  They researched 1,700 articles over a seventeen year period to identify business ideas that rose to sudden prominence only to fall rapidly into obscurity. Does anyone remember quality circles? 

What then is the secret of fads fleeting success? Miller and Hartwick identify eight characteristics that make fads appealing.  They include the fact that a fad operates to a simple, prescriptive formula which is in tune with the spirit of the times.  The one-size-fits-all nature of fads promises results in ways that are novel but not radical.   

Fads are easy to sign up for. They use nice, acceptable language and can usually be overlaid on the existing organisation, making it look good. They also have the effect of allowing organisations claim that they are made a bold move forward. However,fundamental change programmes such as diversification, introduction of shared services and Six Sigma working require more radical and invasive interventions.  That is not to say that fads are of no use.  They can be beneficial in unfreezing an organisation, implementing positive values and providing a sense that things will never be the same again.

How to spot a fad is an interesting question. It is tempting to rely on the research on which the new big idea is based. However, research may mislead as is amply illustrated in a review of the Jim Collins’ management classic “Good to Great.” This book was developed as a result of exhaustive research aimed at identifying what causes some organisations to achieve greatness.  The review is included in a research paper by Philip Rosenzweig which is easily found in another Google search. It completely debunks the impressive reputation that Collins’ book (and many other comparable texts) have built up.  He refers to the ‘halo effect’ that surrounds successful organisations and the false inferences that ensue, resulting in a circular argument and a distortion of causal relationships. 

The lesson arising from these studies is clear.  Firstly, until an organisation has given its existing system every chance of success, it should not go looking for a panacea for all its ills.  Build on existing strengths such as systems, expertise and commitment.  Eliminate problem areas such as absenteeism, poor quality, duplication of activities and needless waste.  There is no reason to believe that an organisation that is unable to manage its existing systems and structures effectively will be able to implement the fundamental change required to transform organisation performance in the future.