5 hitmen and delegation by doctors

5 hit men

The winners of the 2020 Ig Noble Awards have been announced. If you are unfamiliar with this interesting alternative to the prestigious Noble prizes, the “Igs” are awarded annually for research and “achievements that first make people LAUGH, then make them THINK.” News media have followed the ceremony with a range of amusing reports. They include identifying what happens to an alligator’s “voice” when it inhales helium. Then there’s the Ig Noble Peace Prize. It’s goes to rival pair of governments for encouraging their diplomats to ring each other’s doorbells in the middle of the night, then run before the door is answered. And a collection of world leaders are now the bemused recipients of the Medical Education Prize. Their achievement? “…for using the Covid-19 viral pandemic to teach the world that politicians can have a more immediate effect on life and death than scientists and doctors can.”

As they say, research and achievements that make you laugh and then think!

Time to laugh

This year’s Management Prize is an interesting one. Ig Noble have awarded it to five professional hitmen who participated in a dark but comical conspiracy. Here’s a quick summary of the hit that never was.

  • A shady business man, Qin, paid a hitman, Xi, a total of 2,000,000 yuan to assassinate his business rival, Wei.
  • But Xi kept half the money and paid Mo 1,000,000 to do the deed.
  • Mo then sub-contracted Yang-KS for the job and kept a share of the fee.
  • And Yang-KS did the same by passing the job onto Yan-GS.
  • Next, Yang-GS paid Ling 100,000 to complete the hit. That’s just 5% of the original contractor’s payment.
  • Ling met Wei, the target, told him of the plot and they faked the assassination.
  • Wei went into hiding while Ling sent the “evidence” back up the chain of command.

Everyone’s a winner! It could be the skeleton for the mad-cap, feel-good movie of the year. But, as Ig Noble say, some things that make you laugh and then make you think.

Time to think

So, what does this remind you of?

Your first thoughts might well be toward the numerous healthcare related services and projects that are commissioned on a daily basis. A top-level person or body hands some big cash over to a multi-national who sub-contract work to another organisation. They, in turn, pass the work onto a franchise operation within their group which pays a local company of tradesmen to perform a specific task. Done well, with good governance, this can be an efficient and effective way to translate complex national or regional programmes into local actions. But there are risks. One is that cash can needlessly evaporate out of the system at every step. Another is when the person or body commissioning the activities assumes they are being completed to an appropriate standard. They’re blissfully unaware of the harsh reality of unfinished or substandard work.

Involving of chains of people, teams or organisations can end up with systems and ways of working that are costly, over-complex and fail to achieve their well-placed intentions. Take the appraisal-revalidation system for doctors as an example. Few would argue against the ideals. We must maintained standards and strive for improvement. Combining well-planned CPD with reflective learning makes perfect sense as the way to achieve this. Yet too many doctors find the current processes a waste of their time and effort.

Everyday delegation

You may, or you may not, have any influence in such commissioning or national systems. But, even if you don’t, the story of our five hitmen should still make you stop and think. At it’s heart, it is a tale of delegation gone wrong.

How often are tasks delegated to you? How often do you delegate tasks to other people? It happens all the time. It’s essential for continuity of patient care, for general efficiency and effectiveness. All doctors must learn to participate in delegation and learn to do this well. The best approach varies dependent on the abilities and confidence of person you are asking to undertake the work. It also varies dependent on the nature of the task and the reasons for not doing it yourself. Then there’s an additional layer of complexity if the person you are delegating to will in turn delegate onto someone else.

The need for good delegation occurs at the end of every shift, when one team must handover patient care to another. That second team will then handover to another at the end of their shift. When you factor in having a day off, there could easily be five acts of delegation before you are back in contact with your patient. Maybe more.

What lessons about delegation and continuity of care and can you learn from the story of the five hitmen?

Stephen McGuire – Managing Director