Although regulatory bureaucracies are necessary to perform society’s business, these institutions frequently display dysfunctional organization patterns that interfere with efficient and effective conduct of the work they are presumably supposed to accomplish. We have coined the whimsical term bureaucrapathologies to describe these dysfunctional patterns. Bureaucrapathologies waste huge amounts of time and effort, squander resources, and yield poor outcomes. Cropping up wherever bureaucratic organizations exist, bureaucrapathologies have become particularly troubling in health care, research, and education. To illustrate, using metaphors of medical pathology and disease we describe Galloping Regulosis and Assessment Degradosis, problems easily recognized throughout the organizational universe.
In Galloping Regulosis mushrooming numbers of misapplied standards and requirements are dumped from higher levels of the org-chart onto lower levels. Here leadership launches unproven and untested rules and regulations (which they instinctively believe to be worthwhile) that fall short when they are put into practice. Decisions to implementthese regulations, demonstrating flawed decision-making at leadership levels, result from lack of accountability in leadership, “groupthink”, failures of high level advisors to challenge strong-willed leaders who zealously push unsubstantiated private visions, failures of leadership to acknowledge errors or shift direction when major problems become obvious (throwing good money after bad), and ineffective mechanisms by which subordinates or outside groups might impact leadership’s decision-making before it’s too late.

While the intentions and aspirations of leadership might be admirable, their zeal is not shared down the chain of command by subordinates whose job it is to implement their visions. Furthermore, the tools, resources, and preparations provided to carry out the mandates are inadequate for the tasks. Except for petty bureaucrats – close minded obsessive-compulsive personality types who enjoy imposing rules – most subordinates see little value in these efforts and therefore go about their implementation half-heartedly, forced to divert progressively larger percentages of their limited time, resources, and human energy away from what they see as more important work. Consequently, executing these unproven regulatory impositions yields outcomes of dubious quality and worth. For example, professional regulators in Medicine have required physicians to undertake time consuming and expensive recertification examinations every decade or so, but these efforts have not been shown to correlate with or increase quality of their practices. As a result, Organized Medicine is backtracking and revising its previously imposed requirements for “Maintenance of Certification”.

Similarly, Assessment Degradosis occurs when regulators falsely believe that the measures they use adequately define and reliably and validly assess their desired outcomes, when in fact what they are measuring is relatively superficial to what’s required in field situations. Such assessment rituals, in a variety of time-honored tests, constitute “fantasy” measures, offering up the illusion that meaningful testing is taking place. For example, paper and pencil tests might assess certain aspects of knowledge but tell little about how a physician will actually function in high stakes emergency room situations.

Bureaucrapathologies can be difficult to change because they are mired and locked in by administrative history, and may be sustained by special interest groups. Nevertheless, sufficient public outcry from various organized stakeholders and greater accountability of leadership can result in significant revision. Many mistakes could be avoided if prior to launch new regulations and assessment procedures were actually pilot tested. Better understanding of their potential benefits, harms (including opportunity costs) and of the implementation problems that might be anticipated could help considerably.

In addition to Galloping Regulosis and Assessment Degradosis, among other academic bureaucrapathologies we have identified Documentation Proliferans and Meeting Disorders. We invite observers in many other areas of academia, government, and industry to define and describe the many additional forms of bureaucrapathologies yet to be branded.

Joel Yager and JeffKatzman

Publication

Bureaucrapathologies: Galloping Regulosis, Assessment Degradosis, and Other Unintended Organizational Maladies in Post-Graduate Medical Education.
Yager J, Katzman JE
Acad Psychiatry. 2015 Dec

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