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Download Lectures on Biostatistics (1971).
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Download review of Lectures on Biostatistics (THES, 1973).

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This is the title of a paper by Andrew D Oxman, David L Sackett, Iain Chalmers, Trine E Prescott (J R Soc Med 2005;98:563-568). Yes, the third author is Sir Iain Chalmers, the distinguished health services researcher, one of the founders of the Cochrane Collaboration, and Editor of the James Lind Library.

Download the paper.

    Summary

    Background We are sick and tired of being redisorganized.

    Objective To systematically review the empirical evidence for organizational theories and repeated reorganizations.

    Methods We did not find anything worth reading, other than Dilbert, so we fantasized. Unfortunately, our fantasies may well resemble many people’s realities. We are sorry about this, but it is not our fault.

    Results We discovered many reasons for repeated reorganizations, the most common being “no good reason”. We estimated that trillions of dollars are being spent on strategic and organizational planning activities each year, thus providing lots of good reasons for hundreds of thousands of people, including us, to get into the business. New leaders who are intoxicated with the prospect of change further fuel perpetual cycles of redisorganization. We identified eight indicators of successful redisorganizations, including large consultancy fees paid to friends and relatives.

    Conclusions We propose the establishment of ethics committees to review all future redisorganization proposals in order to put a stop to uncontrolled, unplanned experimentation inflicted on providers and users of the health services.

And here is another bit.

Glossary of redisorganizational strategies

Centralization (syn: merging, coordination): When you have lots of money and want credit for dispensing itDecentralization (syn: devolution, regionalization): When you have run out of money and want to pass the buck (i.e. the blame, not the money) down and out

Accordianization: When you need to keep everyone confused by instituting continuous cycles of centralization and decentralization. Best example: the NHS Equalization: When you have not (yet) sorted out which side is going to win

Interpositionization: When you need to insert shock-absorbing lackeys between patients and managers to protect the latter from being held accountable (this strategy is often misrepresented as an attempt to help patients)

Indecisionization trees: When you are massively uncertain and incompetent, picking numbers out of the air and placing them in diagrams. Also used as a party game at management retreats

Matrixization structure: When your indecision tree has been exposed as meaningless twaddle, the introduction of a second indecision tree at right angles to it

Obfuscasization: When you need to hide the fact that you have not a clue what is really going on, or what you should do about it. Makes heavy use of phrases such as “at this moment in time” instead of “now”, and transforms things that are simple and obvious into complicated and impenetrable muddles

R&Dization: When you have been exposed as a power-mad fraud and are offered a compensation package just to get you out of town. Employs the ‘Rake it in and Disappear’ ploy

Black hole effect: When a reorganization absorbs large amounts of money and human resources without producing any measurable output

Honesty: When your corporate conscience urges you to admit that when you say, “It’s not the money it’s the principle”, it is the money. A dangerous and abandoned strategy, included here for historic purposes only.

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