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The fellowship had evidence the Seniors Program delayed frailty. They knew how to postpone a terrible affliction. Yet, when physicians’ economic rationality concluded that doctors were unable to adopt the program, the fellowship bent over backward to create new systems to change the program’s cost structure.
If the fellowship knew how to delay frailty, why not force doctors to adopt it? The BC Health Authority’s CEO championed the program. The fellowship could have asked him to drive compliance, but this never happened.
Should we not fight for what we believe is right?
Fighting in this context refers to the direct use of power to coerce others to comply with your wishes. Rather than seeking an agreement, you wish to force someone’s unwilling compliance. They, in turn, use their power to protect themselves and defeat you.
Fighting is always an option. There are times when a confrontation may be necessary. There are at least four dangers, however, with allowing a disagreement to escalate to a fight, so choose your battles thoughtfully.
- You might lose. Even if you have more power and authority in the organization, the possibility exists that you will lose an outright fight. The costs of losing a confrontation can be severe. The project you want to succeed in may die permanently. You may lose influence in your organization. You might lose your job.
- You will create enemies. Whether you win or lose a fight, you will create enemies. In an organization, people and groups need to work together on many projects over long periods. If you make an enemy over one project, you compromise your ability to progress on all the other projects over which they have influence now and in the future.[1][2]
- The first casualty of war is rationality. Remember from Chapter VI that one of the tactics of power is ignoring rationality. When people and groups seek to overpower others, rationality vanishes. During conflicts, people are not interested in rationality. Instead, they focus on survival and defeating their enemy. Bald power plays dominate, pushing rationality aside.[3]
- You miss out on the potential of collective reasoning. In the above example, technocratic rationality told doctors one thing, economic rationality another. Economic rationality speaks to values of sustainability and robustness. Yes, we want our healthcare system to prevent frailty, but we also want it to be sustainable and robust. It is not that technocratic and economic rationality conflict, but rather that they speak to different aspects of our healthcare system’s overall challenge. The healthcare system does not “win” if one rationality defeats another. The system needs both rationalities, as well as others, to thrive. True innovative breakthroughs come not from defeating other rationalities but from blending them through collective reasoning.
Recovering After a Confrontation
Leaders have to make decisions, which invariably upset someone. Sometimes people choose to strike at you,