Walking softly

by Jinryu

I’m not sure if I mentioned, but I’m technically without a full-time job, even though since my return from Asia, I’ve been working  5-6 days a week at the OR.

One morning, I couldn’t attend a superbeef meeting this because we’re a bit short staffed (nothing new, and that probably made up a tired topic among all employees at the meeting).  I heard a bit about it though and in the following week.  Suprisingly… not many people want to get into specifics.  Was it that big a deal?  What I call the “superbeef” meeting this morning was the discussion of the results following an employee survey. This survey was filled out by over 70 employees from the Operating Room, meaning that it includes clerks, nurses, technicians and doctors.  I didn’t even know that there were 70 people working here to be honest– but I guess that’s possible.  Hosted by an independant consulting company, it is meant to help with service quality control.
Which, if you look at it one way, could spell danger for management.   Generally, survey turnout is pretty low if nobody’s got anything to beef about.  That we apparently got over 70, and I wasn’t even aware we had 70 people total means that there is a hell of a lot of beef!
On the other hand, from personal experience, submission to a survey and outside consultancy is sometimes a method that administration choses as the lesser evil.  It follows this kind of process:
  1. bite a bullet of a one-time forum to air out all the accusations (acknowledge the worker concerns)
  2. make some promises to make changes (involve the workers in the proposed changes)
  3. play the initiatives against eachother, citing lack of ressources as the reason for slow (or non-existent progress) and then, let beaureaucracy kill the rest of the movement.  For bonus points, blame fading worker enthusiasm for the death of a movement.
The fact is, rallying workers together to make a complaint is pretty tough work.  Such moments of decisive action only happen because everyone is angry and riled up all at once– if people get in the habit of justifying bad conditions as status quo, it undermines  the possibility of positive change.  Basic physics tells us that F=ma: force is by mass multiplied by acceleration.
So either people drop out of the movement, or people slow down, and there goes your movement.
A week or two back: a nurse was yelled at by a surgeon in one of our surgical theatres for something that wasn’t her fault.  She tried to explain, but he wouldn’t have anything of it and continued to berate her. She left the room, in tears. She went to her nursing manager, whose response was: “There are good days, and there are bad days.”
Do you think this is an adaquate response?
A few months ago, before my contract ended, there were a number of issues with a software upgrade.  The  bugs were so numerous that it was having a severe impact on my productivity, because I’d have to use manual workarounds.  Just today, someone who works on a government health ministry project gave me a call asking for my help in fixing something that was a problem several months ago, that we’ve only discovered in the past month.  I’m being vague about the details because I’m under a confidentiality agreement… but the jist of it is that for months, nothing was done about numerous reports that I’d made about the problems that the current system would lead to.  It’s only when I was caught between a  two administrative powers that anything happened– I played one against the other, effectively holding my cooperation hostage, until one of these parties could give me a good reason to help them.  It was kinda risky to be honest, but it seems that I got lucky and I came out on the winning team.  A month after I left on vacation, it seems that magically, a fair number of the system issues have been resolved.  And now, other departments are calling me up for help with their miscelaneous problems, because they heard rumors that I’m in a position to help them now.
Now, that sounds like a success story.  It’s not.  Do you think it should be normal procedure in a public health care facility that I have to use such methods to make things work?  Should I need to hold information and cooperation essentially for ransom to other departments, just so I can get help?  Aren’t we all on the same team?
In the over ten years that I’ve been on this blog, during which I was employed mostly at government funded instituations, I’ve come to a few conclusions about the way that we do work.  The first of which is that leadership is infinitely important, and every organization knows that– but many organizations end up following the Dilbert Principle, which is that the dumbest and most incompetent people end up getting promoted to the positions with decision-making power.
All the problems in the OR stem from a fundamental lack of transparency and goal setting on the part of management.  Everyone knows what they’re supposed to be doing, sure– so why do internal conflicts within hospital staff occur? Because how our jobs interact hasn’t been clearly-enough defined.  Beaureaucracy to be sure is something that a lot of people frown upon– but it exists because in large organizations, there’s no way to micromanage personal relationships with every network contact we have.  Without rules and a SOP (standard operating procedure) we’re left at the mercy of individual agendas– and while an SOP doesn’t make it impossible for people to exploit the system, frameworks of principles and objectives need to be in place to at least define what the instituation is all about.  
We need standard operating procedures that provides buffers– we have distinct jobs that produce distinct work, which we throw into the stream of beaureacracy, that acts as a buffer, and then it hopefully gets picked up by someone downstream who is doing their job the way they should.
The problem is that managers can’t just be greedy bastards and try to steal ressources from other departments– they can’t just wait for good things to float to them from upstream.  They have a job to talk with other managers– make sure that their own departments are in line with departmental goals. Actually, first of all, as I already mentioned, managers need to set departmental goals.  And by departmental goals, it will need to be more specific than some PR fluff like “to provide the best quality care for life.”  That’s the motto of the MUHC– but while it’s good to show to the public, it’s not nearly relevant to departments who are at the front and back lines.  

In the past, back when I was at the Montreal Chest, I got into some conflicts with managers because I didn’t like the way they run things, and so I made efforts towards what I considered positive change.  Part of my contributions there, as well as at my previous department at the Children’s (Emergency) was to write up a procedure reference guide– a standard operating prodcedure.  The one I wrote for the Chest resulted in some beaureucrats having their jobs rearranged, but the one I started at Emerg (I didn’t finish it before I jumped ship to join OR) probably fell into political limbo.
… all that said though, without inflating my tires, I do a pretty good job at the OR.  I handle high stress situations professionally– nobody gets to me.  I’ve put some people in their place.  I do my job.  That’s because I believe in my work.
I also believe that management in my department is clearly a countervailing force to my efforts, as well as those of my peers.  But, the question is: will I do something about it?
… and, needing good reference letters for law school applications… can I risk rocking the boat?
maybe nothing changes because everyone carrying a big stick is too busy walking softly.