Resistance to Goals, Targets & Estimates
Reflex resistance to imposed obligations
At a recent business incubator breakfast, I listened to a presentation about goal-setting in the software industry. The speaker described steps he’d instigated as his company COO to keep management and staff focused on their core mission of developing software applications for business. He had created a healthy balance between 90-day targets consistent with the rapid product evolution of the industry and 1-year goals for the overall strategic direction of the company.
The lively debate that followed suggested his approach resonated with his business colleagues and led to my musing on the challenges of having physicians buy into the merits of setting targets for success. We are at best ambivalent about goals and can show a particular resistance when we experience financial or work productivity targets imposed (or feel like they’re being imposed) by management figures, with or without medical degrees to their name.
One part of me understands this and is sympathetic, the other scratches my head and wonders would it be that hard. Don’t our early adult lives not suggest we are masters at goal attainment as we move along over the hurdles of our educational systems collecting the necessary pieces of parchment? Perhaps it’s to do with an ‘imposed achievement-fatigue’ setting in at about age 30?
I’m unconvinced we actually process this at some intellectual level though and see it more as a reflex resistance to imposed and extraneous obligations.Post-hoc rationalizations we may articulate are along these lines:
- Our daily experience of patient care illustrate the gap (or is that a chasm) between ideals and reality - noncompliant patients, variability in natural history of disease or the difficulty of pinning down the multitudinous confounding variables that result in the success or failure of our interventions on behalf of patients leave us skeptical of the merits of targets and the huge gray border zone between correlation and causation.
- We see goals/targets etc. as processes that smack of the corporate and business world. We dislike conceiving of ourselves as working in an industry and have a distaste of working for a corporation, albeit that this may indeed be the case.
- Physicians have an independent streak matched by few other professions. We claim that healthcare is a special case and thus not subject to the usual rules and roles. We can’t really back this up in some particularly factual way so tend to fall back on the sacerdotal nature of our work in caring for mankind insulating us in a way that’s not dissimilar to how many religions, notably the Roman Church of my upbringing, plead their case. A corollary of our independence is hubris. Years ago, a colleague running a large clinical department losing a ton of money told me: “I never pay any attention to young MBA types telling me what to do.” Indeed, all the signs were on it, and, the financial health of his department improved significantly when a more enlightened successor took over.
- Change-fatigue bedevils many members of our profession. Targets and goals mean more paperwork, more monitoring, more time away from patient care and our personal lives. Moreover, once instituted, the goals only seem to multiply.
Yet, having said all that, it’s tough to argue with the merits of goals. We’ve used them to our own advantage as we advanced along the career pipeline. It’s likely we extoll them to our children and out students. So they are good when you’re striving and unimportant when you’ve arrived.
Except.
Except, the real world and real life is all about transition, while stasis is decline or worse yet, death.
And, don’t goals, targets and estimates aid with transition?