A Unified Field Theory to account for managerial ineptitude and general hosebaggery in hospitals. Ladies and gentlemen, I give you The Iron Law of Oligarchy:
Any large organization . . . is faced with problems of coordination that can be solved only by creating a bureaucracy. A bureaucracy, by design, is hierarchically organized to achieve efficiency—many decisions have to be made daily that cannot efficiently be made by large numbers of people. The effective functioning of an organization therefore requires the concentration of much power in the hands of a few. Those few, in turn—the oligarchy—will use all means necessary to preserve and further increase their power. . .
This process is further compounded, as delegation is necessary in any large organization, as thousands—sometimes hundreds of thousands—of members cannot make decisions via participatory democracy. This has been dictated by the lack of technological means for large numbers of people to meet and debate, and also by matters related to crowd psychology . . . that people feel a need to be led. Delegation, however, leads to specialization—to the development of knowledge bases, skills and resources among a leadership—which further alienates the leadership from the rank and file and entrenches the leadership in office.
Bureaucratization and specialization are the driving processes behind the Law. They create a specialized group of administrators in a hierarchical organization. Which, in turn, leads to the rationalization and routinization of authority and decision-making, a process described first and perhaps best by Max Weber, later by John Kenneth Galbraith, and to a lesser and more cynical extent by the Peter Principle.
The organizational characteristics that promote oligarchy are reinforced by certain characteristics of both leaders and members of organizations. People achieve leadership positions precisely because they have unusual political skill; they are adept at getting their way and persuading others of the correctness of their views Once they hold high office, their power and prestige is further increased. Leaders have access to, and control over, information and facilities that are not available to the rank-and-file. They control the information that flows down the channels of communication. Leaders are also strongly motivated to persuade the organization of the rightness of their views, and they use all of their skills, power and authority to do so.
Bonus points if you can think of ten ways that the Iron Law acts to the detriment of nursing practice in your workplace.