1. “There is only one right idea. But everyone’s got it” Democracy vs dictatorship in management Nav Ahluwalia Executive Medical Director 14 November 2014

2. Take home messages Trusts are not democracies Leaders need to deal with 3 challenges – Manage Chaos – Through Relationships – To develop Trust

3. Overview Why this topic? Difference between democracy and dictatorship Models of democracy Pros and cons of democratic structures How to avoid chaos

4. My Aunt Kath and shoes “There’s only one perfect baby. And every mother’s got it!” Shoes inappropriate for the beach. One tells the other kindly. The other is horrid, rude, formal action: “CHANGE!!”

5. What is Democracy? Common good can emerge “from chaotic, reciprocal interaction among people with potentially conflicting goals, values and ideals” Autonomy Acceptance of competing interests Reasoned debate

6. Democracy versus dictatorship “Love of power is one of the strongest human motives” “In a dictatorship the information is manipulated but the people know it and in a democracy the information is also manipulated but the people do not know”.

7. Imagine a Trust Dictatorship… (1) The small number of people who share power with the dictator. (2) The people who benefit from supporting the dictator. (3) The brain-washed group which supports the dictator due to the monopoly of information. (4) The group which supports the dictator to avoid harm. (5) The group who opposes the dictator but remain silent. (6) The group which opposes the dictator and is active in speaking and/or writing. (7) The small group which use violence against the regime.

8. An Ideal Trust Democracy? Representation or direct democracy Decentralization to avoid accumulation of power. Parties and independents in representation. No concentration of information and building mechanisms to avoid its misuse

9. Levels of Decision Making Participation vs rule Employee control? What issues? At what level?

10. ‘Democratic’ Trust Public perception of professionals Cognitive and affective components Helps tolerance of uncertainty and risk

11. Medical Leadership 1.MANAGE CHAOS: leaders need to be able to encourage differences but keep the ensuing tensions “within bounds through 2.RELATIONSHIPS leadership power is derived from successful relationships rather than hierarchical position to develop 3.TRUST Within and without the organisation