In Australia, very few direct government services are provided by the Commonwealth. Kevin Rudd wants to change that with regard to the hospitals, because he has a view that he can do it better than the states. Two things concern me about that. Firstly I think that's the naive view of someone who's never had to do it - deliver direct health services; secondly the Rudd government has, disappointingly, shown itself to be completely unable to deliver anything except mindless blather. I don't expect that to change if they get their hands on the hospitals. And just whilst we are digressing: it seems (from what little we have been told) that one of the key planks of the "Rudd Hospital Plan" is to give more power to, inter alia, the doctors. Wrong move! Assuming that doctors know how to improve or run the health system is just plain wrong and confused thinking. It confuses the delivery of clinical services with the management of a highly complex and resource hungry system. I have great respect for the ability of doctors to deliver clinical services. That does not mean that they have the ability to manage a complex beast like the health system. Demonstrably they are part of the problem and their role in the solution needs to be carefully managed.
But back to the subject in hand. The most populous state in Australia is NSW (around 7 million +) followed by Victoria (5.5 million +). NSW seems to be chronically unable to deliver services and chronically unable to make the money stretch. Hospitals in NSW, in particular, are creaking and groaning at the seams. If you also think about places like the US and India it appears that they have similar problems.
Now I know that this is painting with a very broad brush, but give me some license here! This is an embryonic thought. Let's just assume that my hunch is right - that at some point government becomes too big and hard and we start to fail to deliver. I came to thinking that this might be because of a pair of linked issues:
- Is our system of government designed to cope with the scale issues that emerge as the scale grows? Systems theory shows us that systems develop emergent issues as they grow and change - issues that were not previously apparent but which emerge due to some change in system scale or structure;
- Are the humans who manage the system reaching the limit of their capacity to manage the complexity and the issues that arise? It's an interesting point to ponder. Management is a process of simplification and distillation. We make the complex understandable and manageable. I wonder if there is a limit to our capacity as humans to do that and whether we see that arising in government performance.
If this is an emergent issue of government systems, at what size do these issues emerge? Is it between the size of Victoria and the size of NSW?
PhD students and other researchers can take this idea and run with it - with attribution - just tell me what you find out -;) I'm interested!