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Healthcare organisations are a complex mixture of personalities, teams, functions and professions, all of whom serve a confusing array of masters including patients, families, populations, political leaders, professional bodies and regulators. Unsurprisingly, this leads to confusing array of often competing goals that can motivate people’s actions. The resulting friction between goals often descends into interpersonal stereotyping and blame. A potentially more productive approach would be to learn to analyse and navigate the multiplicity of goals at work in organisations, and how they impact decisions.

This essay aims to lay out research that examines organisations as systems of nested goals with the intention of better equipping you to analyse and navigate the goal system in your organisation in a way that can help you better perform as a medical leader. A basic idea of this research, grounded in The Behavioral Theory of the Firm,1 2 is that organisations have a multiplicity of independent and often competing goals. Different goals in an organisation can each have relatively independent effects on decision-making, Organisational politics, where different organisational members prioritise different sets of goals, play an important role in determining which goals are ultimately prioritised and pursued. The idea that goals are important to well-functioning organisations is widely understood. For example, managers routinely attempt to motivate people and work teams by defining goals that are specific, measurable, agreed on, reasonable and with a defined timetable.3 Research on how organisations cope with a multiplicity of goals has been less widely communicated.

That a multiplicity of goals exists and is important in shaping organisational decisions, however, is clear. A hospital, for example, can have diverse goals, including operational efficiency, adhering to professional and regulatory standards, …