Management Heresy

Heresy — noun

(ˈhɛrəsɪ )

1. An opinion or doctrine contrary to the beliefs of an organisation
2. The act of maintaining such an opinion or doctrine

An interesting word

And an interesting activity. I often wonder about heretics. Are they a bunch of loony tunes who can’t see how wrong they are? Or are they perfectly sane people, fighting bias and conformity with evidence? People who stand up when others aren’t prepared to be counted?

Bloodletting

Since antiquity — which was a long time ago — one of the fundamental beliefs in medicine was humourism.  Doctors believed that the four humours (the body fluids phlegm, black bile, yellow bile and blood) maintained the body. These were related to the four elements: fire, earth, water and air.

If somebody was unwell it was due to an imbalance in the humours. Logically then, it followed that to cure an illness a doctor had to rebalance the humours.

It was tricky (and uncomfortable) to lay your hands on black or yellow bile and there was only so much phlegm to go round. So the simplest way to restore equilibrium was bloodletting. Sometimes this was done with a leech. In more extreme cases a surgeon would “breathe a vein” letting the blood out by the pint.

Bloodletting was a standard practice regardless of the illness, be it a migraine or the small pox. The more unwell a patient was, the greater the imbalance they were suffering from, the more blood the doctors released.

The result:

Bloodletting had two outcomes. Either the patient lived or died.

• If the patient lived then it proved how effective bloodletting was and reinforced the treatment.
• If the patient died then the doctor would shrug his shoulders and say: “The patient must have been incredibly ill, even after I let out all that blood they still died.” Which also reinforced the treatment.

Bloodletting was practiced by ancient Greek, Roman and Islamic physicians. It prevailed as a cure right the way through the middle ages.

The heretic

It is very easy for you and I to shrug and ask “what were they thinking”. If, however, you are sitting in the middle of such madness, trying to get others to see the stupidity of the situation is not so easy. You will be roundly criticised and denounced as a heretic.

In the 1800’s A French physician,  Dr Pierre Louis, developed “La method numerique” to study the efficacy of medical treatments.  He used data to support his actions.  In 1828 he studied the effect of bloodletting on 77 patients with pneumonia.  His understated conclusion was that the impact of bloodletting…

Was actually much less than had been commonly believed

A good stiff ignoring

The medical profession resisted Louis’ arguments.  They were not ready to look at the evidence or conduct their own tests.  It is estimated that in 1833, five years after Louis published his findings, French doctors imported 42 million leeches for medical use.  That is not the action of a group of men who were coming around to Louis’ way of thinking.

Louis’ “method numerique” became one of the most fiercely contested approaches in French medicine.

Medical conservatism carried the practice on into the twentieth century.  As late as 1942 a medical textbook was published that still recommended bloodletting as a treatment for pneumonia.

While Louis may not have prevailed he is now credited as one of the fathers of evidence based medicine.

What about the others?

Louis’ story is interesting if only because it prompts another question…

In the preceding 2,000 years how many other physicians were sceptical about the practice? The miracle cure-all with its complete lack of supporting evidence. How many doctors came to the conclusion it was nuts, but kept their mouths firmly shut?

How many could have changed the course of medicine, but decided instead to toe the line?

Management heresy

We follow our management beliefs every bit as blindly as doctors follow medical ones.  Regardless of the consequences.

Let me be a heretic and challenge some beliefs. Here is my list of management claptrap.

• Our staff must be 100% efficient — what would happen if you gave some time off?
• We must plan before we act — could you test before you act?
• Targets motivate — to do what?
• We must have the best people — are there that many best people?
• The job if a manager is to tell his staff what to do — or do what his staff ask of him?
• We don’t have the resources we need — how about being resourceful?
• We must hold people accountable — but not ourselves?
• All the low hanging fruit has gone — who went looking?

Sink or swim?

Before you throw me in a river tied to a rock like a modern-day witch, ask yourself a question.

Can you improve anything without a little heresy?

Do you want to change things for the better, or are you going to play it safe and toe the line

Come on in. The water is lovely.

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