Executive Realities

A physician has no problem of effectiveness.
The patient who walks into his office brings with him everything to make the physician’s knowledge effective. During the time he is with the patient, he devotes himself to the patient. He keeps interruptions to a minimum. The contribution the physician is expected to make is clear. What is important, and what is not, is determined by whatever ails the patient. The patient’s complaints establish the doctor’s priorities. And the goal, the objective, is given: It is to restore the patient to health or at least to make him more comfortable. Physicians are not noted for their capacity to organize themselves and their work. But few of them have much trouble being effective.”

The executive in the organization is in an entirely different position. There are many realities over which he has essentially no control. He has no choice but to “cooperate with the inevitable.” Every one of these realities exerts pressure toward nonresults and nonperformance.

The executive’s time tends to belong to everybody else. Operationally (that is, through his activities) he is a “captive of the organization”. Everybody can move in on his time, and everybody does. He cannot, as a rule, like a physician, stick his head out the door and say to the nurse, “I won’t see anybody for the next half hour.”

Whenever a patient comes in, the doctor says, “Why are you here today?” and expects the patient to tell him what is relevant. When the patient says, “Doctor, I can’t sleep. I haven’t been able to go to sleep the last three weeks,” he is telling the doctor what the priority area is. Even if the doctor decides, upon closer examination, that the sleeplessness is a fairly minor symptom of a much more fundamental condition he will do something to help the patient to get a few good nights’ rest.

Events rarely tell the executive anything, let alone the real problem. For the doctor, the patient’s complaint is central because it is central to the patient. The executive is concerned with a much more complex universe. What events are important and relevant and what events are merely distractions the events themselves do not indicate. They are not even symptoms in the sense in the patient’s narrative is a clue for the physician. If the executive lets the flow of events determine what he does, what he works on, and what he takes seriously, he will fritter himself away “operating. The executive needs criteria which enable him to work on the truly important, that is, on contributions and results, even though the criteria are not found in the flow of events.