How to defeat the vertical

I’ll say right away that this is not about politics or revolution, not about mass street protests. Although this is also a useful thing. In general, it’s not at all what you immediately think about out of habit. But at the same time, these are not general and abstract reasonings like “if we all say it out loud,” or “we will all come out together and demonstrate,” or “how indifferent and indifferent we all are,” etc.

In essence, this is a practical guide, a small instruction on how to establish public control over power.

Local doctors asked me to speak at public hearings on the problems of modernizing healthcare.

I already knew roughly in advance what direction the discussion would take. First they will talk about problems: wages, personnel, equipment, patients, management, and so on. And then a representative of the department (a person from power) will have to speak and solve all the pressing problems on the spot. Well, or promise that all comments and suggestions will be taken into account in further work. Thanks everyone for your valuable suggestions. And then, as usual, the parties disagree, but the problems remain.

Knowing such scenarios, I proposed a slightly different scheme to those present. Why doesn’t the government come to your discussions? Or does he come, promise and not deliver? If it's rude, then she doesn't respect you. And they don’t consider you as a real force.
Why? And you cannot influence the decisions made. Neither directly nor indirectly. Therefore, your opinion can be ignored.

And you yourself are to blame for this. You allowed all the commanding heights in departmental management to be seized, you removed yourself from management functions, delegating all decisions to an official. But he has usurped this power and is abusing it. There is no control, which means it can be abused. Logical? Logical.

What to do?

To begin with, ensure control over the authorities and the decisions they make. At least in this way, the number of stupid and suboptimal management decisions will be sharply reduced, and the number and scale of abuses will also be significantly reduced - it will be much more difficult to do this, and you can get caught. Risky.

Officials do not like to make individual decisions. This is a responsibility. He always needs to cover his ass... uh, back. For this purpose, there are so-called collegial bodies. But they are formed for a specific boss in order to be an obedient tool for his management decisions. A loyal composition is formed and the organ turns into a convenient tool for stamping out the actions of the chief executive.

It is necessary to reformat the composition of such collegial bodies.

In the Kirov regional healthcare, I counted at least four important collegial bodies, on whose decisions the head of the department relies: the Board of the Department of Health, the Interdepartmental Commission for the Development of Healthcare Modernization in the Region, the Board of the Territorial Health Insurance Fund, and the Conciliation Commission on Tariffs for Medical Services.

Having carefully studied the composition of all the above bodies, we can say that they are all ruled by the same two or three people from the regional government. This is not good, as it leads to the very abuses that we are all trying to fight (light laughter).

To bring the activities of such “collective minds” under control, it is necessary to include in their composition specialists whom you, in your professional community, respect and trust. And also, so that they are sufficiently independent from any actions of the management of the health department.

The doctors really liked this proposal and, as far as I know, they have already begun to implement it.

How and in what way? I won’t say yet, so that the opposing side does not interfere in this process. And then in each region the situations are very different and we must act in accordance with real conditions. But there is only one tactic - to regain what was lost - control and influence.

I will immediately answer all those who say that this is unrealistic. Try it first. If something doesn’t work out, write me, I’ll tell you. I will advise. And if she’s really full of ass, then welcome to public and other events. And you already know exactly what to demand. Well, sitting and crying about how bad everything is is not a position for doctors.

PS. By the way, teachers can also take note. And cultural workers should have woken up long ago.

If you win at this level, you can move on. And one more thing. There is no need to get hung up on Putin, like “Putin will go away and we will be happy.”

Political struggle does not cancel the forms of civil and public participation of the country's citizens in governing their state.