Strategies for Organization Design

9Responsibility

“The swings between centralization and decentralization at the top of large … corporations have resembled the movements of women's hemlines.”

—Henry Mintzberg, The Structuring of Organizations (1979)

One of my favorite clients was a new COO in a large integrated health system. She had quickly come up with a list of improvements to make to the company's operations, with an early example being a simple tool to streamline resourcing that was an industry best practice and widely used at other similar health systems. Being new, she searched for the appropriate approval process and was pleased to find a governing body that reviewed and approved the implementation of the new tool.

However, she also found a couple of other leaders, committees, and governing bodies that this group wanted her to seek approval from as well. Slightly discouraged, she sought approval in a few more places. Slowly, she was able to present, discuss, and receive approval from these additional people and committees. But these approvals were conditional on her seeking approval from yet more people, and then some more.

Fast forward nine months and 45 approvals later, she launched the implementation of this simple improvement tool. Unfortunately, after all of this, she was stopped dead in her tracks by a lone executive who had somehow been left off of the previous 45 approvals; they were just not sure they approved and wanted more time and information to decide. A year later, when my client quit ...