Effects of bureaucracy in health care

Bureaucracy is a type of formal administration with the characteristics of division of Labour, rules and regulation, hierarchy of authority, impersonality of social relationships and technical competence, among others. The essence of bureaucracy is to enable large organizations to be managed, to achieve efficiency and be more accountable to the people. In other words, bureaucracy is the coordination of organizational activities for effective, efficient and economical provision of services by public and private organizations.

Bureaucracy is a very useful tool in management (and by extension, management of healthcare) but it certainly does not present itself as an ideal management tool because it has its own demerits. Some challenges imbibed within the theory of bureaucracy are explained below:

It is difficult to determine who is responsible for having made a particular decision, creating afeeling of powerlessness amongst employees. Under the bureaucratic model, there is a long chain of command and this makes it difficult to detect or trace the point where wrong decisions are made. As a result, it ends up in a blame game which makes the employees most vulnerable to blame. In such events, the employees feel powerless as they become the bearer of the blame because they occupy the base in the chain of command and are mostly the implementers. For example, in the supervision of surgery by a consultant or specialist, a junior medical officer is the most culpable in the event of an error even when the junior staff acts on the orders of the specialist or consultant.

There is diffusion of responsibility and subsequent refusal to make a decision. For example, to get something done you need 6 different approvals on 6 different forms and eachrefusing to give approval until the other 5 have given theirs. This accounts for the delays encountered under this type of management. The approvals are meant to ensure proper checks and balances to make sure that the right things are done. However, when it becomes excessive and preposterous, it tends to stall progress.

It is too difficult to determine specific individual contribution to successful patientcare outcome. Mostly, the work is done synergistically and the result is seen as the combined effort of the entire hierarchy as against the efforts of one particular person. This creates a placebo of honours and recognition as individual efforts can hardly be noticed and recognized appropriately.

The top bottom hierarchy does not utilize specialized lower level to make decisions intheir field of specialty and does not allow people to use common sense, as everything must be as written by the law. Bureaucracy undermines active innovations of people at the bottom of the hierarchical order because decisions and commands only flow from the top to the bottom and that makes the “bottom dwellers” only implementers. Therefore, obviously ingenious ideas cannot flow from the bottom to the top of the ladder. Since they are hardly engaged in decision making. At best, their propositions only become suggestions.

Organizational structure is too inflexible to effect necessary changes efficiently. It is difficult to change the rules, regulations and procedures that has already been laid down by the hierarchy. This makes it immune to change for progress and development when necessary. This leads to rigidity; making decision-making slow or even impossible when facing some unusual case, and similarly delaying change and evolution

Overspecialization, makes individuals not aware of larger consequences of their actions. People tend to become contemptuous and over-confident of their roles after a period of time spent on the job. This makes them ignore certain warning signs that need to be critically observed and this makes room for larger errors to be committed, either advertently or inadvertently.

Bureaucratic management within the healthcare systems in Ghana can be exploited to improve health care delivery in several among many ways. As a social concept, bureaucracy is subject to various challenges and might be linked to various disadvantages but they can be effectively managed to ensure that we harness the prospects of this system.

First and foremost, bureaucracy creates an opportunity for employees to become specialists within one specific area, increasing the effectiveness and efficiency in each area of the organization. This eliminates the “Jack of all trade, master of none” syndrome that places seemingly versatile people into places that require competence yet lack the rich experience and expertise required to execute those tasks effectively and efficiently. Therefore, with bureaucratic system of management, it is ensured that highly skilled and efficient people who have the right expertise will be able to deliver to the best of their ability.

Bureaucracy promotes creativity and stability within their respective duties and sub-tasks. With the strict, rigid and firm structure associated with bureaucracy, coupled with the consistent practice of the rudiments within the officially assigned tasks, it gives people the wealth of experience for them to enable them mature within the tasks assigned and it makes it easier to manoeuvre around even more difficult tasks and duties required.

Bureaucracy can be exploited as a management tool to motivate employees within the health care setting to promote effective and efficient discharge of duties. This is because bureaucracy protects employees from unfair rulings from leaders which gives a greater sense of security to the employees. It also has a well-governed system that ensures promotion devoid of impersonal rule. This motivates the employees to give off their best in an attempt to feed their aspirations of climbing into the higher class of management.