Chapter

1
THEY CAN’T LIVE WITH EACH OTHER,
CAN’T LIVE WITHOUT EACH OTHER

A BOOK ABOUT PROFESSIONALS AND MANAGERS

This book deals with a relationship full of tension: the one between managers
and professionals. Professionals are the people who do what is called the ‘real
work’ in our society. They are engineers, judges, medical doctors, teachers, police
officers, actors, pilots, and so on. They maintain power plants, they pass verdicts,
they operate, they teach, they catch criminals, and they move and inspire us.
Their work often requires specialist knowledge, which they can only maintain
by constantly gaining new experiences. For many professionals, their profession
is their passion: they are strongly motivated because they love what they do.
In the past few decades, professionals have increasingly been confronted with
managers: non-professionals who manage the professional organization. The
often-heard complaint is that there are too many managers, and that they are
too powerful while they know too little about the profession. The added value
of all these managers is unclear to many professionals – especially when it
concerns managers who do not come from within the profession. Management
causes hassle, and as soon as managers are in charge, things no longer happen
spontaneously.

PROFESSIONALS NEED AUTONOMY …

This is an often-heard wisdom that will appeal to many professionals.

Professionals should be allowed to do their work and should be bothered with
as little organizational and bureaucratic hassle as possible. Someone who per-
forms complex tasks needs autonomy and has a right to be trusted with the
responsibility to perform these tasks well. Managerial control mechanisms are
superfluous in well-functioning professional organizations. Professionals are
always embedded in a professional community, with its own codes that con-
tribute to the quality of the service delivery. This mutual professional control
2 Managing Professionals

has much more added value than managerial control mechanisms. In addition,
there is the phenomenon of professional pride: professionals generally have a
strong intrinsic motivation and take pride in their work. By definition they will
make an effort to do their work to the best of their capabilities. Professional
autonomy is the best guarantee for a high quality professional service delivery.

… AND THEREFORE MANAGERS ARE THE PROBLEM

Much of the hassle in professional organizations is caused by managers.

Managers know less about the profession than their subordinates do, and
therefore they resort to useless protocols, plans and procedures. Protocols, plans
and procedures result in an enormous burden of proof imposed upon profes-
sionals. Before they can act, they have to prove that their actions meet the
requirements of the protocols, plans and procedures. There is no room left for
what is called ‘professional audacity’: acting professionally, also when there is
limited information or time. Managers break the basic rule – that professionals
need autonomy. Someone who seeks refuge in protocols, plans and procedures
will deliver a sub-optimal professional performance in the end. The conclusion
should be that fewer managers equals less hassle and more professionalism.
Of course no one will deny that there is a need for managers. After all, some-
one needs to take care of the buildings and the equipment – but the question
in a professional organization should always be: what is the added value of the
echelons above the professional? Professionally, a university professor is the
one expert in his organization. His organization’s raison d’être is to enable
research, including his own. The logical question is: what is the added value of
the echelons above the professor? What is the added value of the dean of his
faculty? And of the board? Of the various staff departments? It is the managers
who carry the burden of proof; in fact they should be the ones to go through
the hassle of protocols, plans and procedures, instead of our poor professionals.

… AND THEREFORE MANAGERS ARE ALSO THE SOLUTION

So far this line of reasoning will be appealing, but it calls for a critical note.
Society is becoming increasingly demanding and complicated. This gives rise
to new questions, which do not always correspond with the interests and the
values of professionals. Technological developments and the ageing of the popu-
lation strongly increase the need for medical professionals, both quantitatively
and qualitatively. At the same time, there is a strong cost increase. The logical
consequence is that an effort is made to limit these costs. The strong demand
 They can’t live with each other, can’t live without each other 3

for legal services – and other professions – is resulting in increasingly long

waiting lists. It may therefore be necessary to introduce new standards that
are different, sometimes even radically different, from the existing professional
standards. We want our professional organizations to use new and often very
costly technology, but some of them are too small for this and can only do this
by merging with other organizations. We want teachers to listen to the parents;
we are sometimes frustrated because they don’t, and wonder why the school
has not come up with a solution for this kind of situation. Cost control, new
standards, mergers, complaint arrangements: they do not always spontaneously
emerge from the professional community – professionals may even oppose
them – and yet we want these issues to be addressed. Not addressing them may
affect the quality of the service delivery. Moreover, some of these issues require
a kind of expertise that differs from the professionals’ substantive expertise.
Or, put differently, they require another kind of expertise in addition. It is not
unlikely that a professional, when asked for his initiatives in relation to these
issues, will refer to the manager. The idea that professionals need autonomy
can also be used as an argument in favour of more management. Questions that
are directed at the organization and that have nothing to do with the content of
the profession should be answered by managers. This will allow professionals
to focus on the things that are important to them.

ABOUT THIS BOOK

If all of this is true, then there are two obvious conclusions. One: managers
exist, they do useful things, and they will therefore always keep existing. Two:
there will always be tension between professionals and managers – they are
often each other’s countervailing power. The doctor represents medical quality,
the manager represents cost control, and both of them are right. The manager
and the professional represent two different world views that are both correct.
They often cannot live with each other, but they cannot live without each other
either. And perhaps they are both unsatisfied in the end. The manager is unable
to achieve the cost control that he envisioned, and the doctor has to compromise
what he sees as quality.
In this book I will therefore assume that there are managers in professional
organizations and that they can have a useful task. Managers and professionals
cannot live without each other. This does not mean, however, that managers are
always right. On the contrary: management can be a major problem in profes-
sional organizations – all too often, managers and professionals cannot live with
each other. But we should keep a certain balance in mind: managers can also
be a solution to problems that exist in professional organizations. Therefore
4 Managing Professionals

Chapter 2 will illustrate why managers are often a problem, while Chapter 3
will explain why they can also be a solution.
Reality, in other words, is often less simple than it appears to be. We will often
have to look beyond simple management bashing, but also beyond the many
all-too-simple tools and models that suggest that professional organizations
are ordinary organizations.
Based on the observations in Chapters 2 and 3, I will deal with a number of
themes: strategy (Chapter 4), quality (Chapter 5), coordination and cooperation
(Chapter 6), knowledge and innovation (Chapter 7), performance (Chapter 8)
and change (Chapter 9). Chapter 10 contains a few concluding remarks. The bot-
tom line is that ‘either/or thinking’, whether from a professional or managerial
perspective, yields a picture that is too simple. This means that some pictures
that I describe may be counter-intuitive – for the professional, for the manager,
or perhaps for both these groups.