Too Busy

I continue to be amazed at the creativity some people have. I’ve even heard some staff boast that they were “The Kings and Queens of Workarounds” because they knew how to get things done through back channels, crisis management, and personal connections that were never listed in any procedure manual. They are too busy to follow the established procedure, which “may look good in some book but doesn’t work in real life!”

I believe that one reason for this is that people lose sight of the reason they are providing the care. In handling patient issues on adaily basis, the issues become “routine” for the healthcare providers, and patients become “workload.” That’s why you may hear staff complaining that a certain patient pushes the call light too frequently, for example. Most people will seek the “least effort method” – whatever causes them the least effort is their own most efficient process – and they don’t stop to think about the impact of their personal changes on the rest of the process flow.

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I was involved in a Rapid Improvement Event recently where we queried the Human Resources folks about the customer of their nurse hiring process. The voting tallied pretty evenly at 50% for nurse candidates; and 50% for nurse managers. We had to dig a little deeper to get the “aha” moment of the true customer: our patients, who need nurses to provide appropriate clinical care; and the faster we fill vacancies, the better staffed our hospital units are, and presumably the better care we can provide to our patients.

Why did this take 15 minutes of discussion? Because the group was focused on the workload of hiring a nurse, and not the outcome. The re-focusing exercise helped the group to break some log-jams during the RIE when we looked at a few sacred cows.

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Part of our work, as J P Spencer wrote in his August 25 blog, is to be change agents as well as statisticians. Helping our improvement teams to remember the difference between their calling and their workload is an essential part of that job.

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Comments 5

  1. Meikah

    This is a good exercise, Sue! Thanks for the idea. In every job we have, there’s always that confusion about our calling and the tasks that we have to do. And I believe, knowing the difference will improve the way we handle work.

  2. Andrew Hillig


    I have heard many of the same comments that you highlight in the first paragraph, and I too struggle with getting the staff to see the big picture. It’s certainly not easy, and any change management techniques I try don’t seem to work.

    I think they do think that their method is the most efficient because it is the least amount of work for them. What a poor attitude to have in a industry where we are supposed to be treating a patient’s condition. Also very sad in a day-in-age where healthcare organizations are finding ways to do more with less. Unfortunately, the people with this type of attitude probably won’t find themselves with a job if the future of healthcare keeps going in the direction its going.

    Good luck with change management, it is definitely easier said than done.

  3. Sue Kozlowski

    Hi Meikeh and Andrew, thanks for your comments. When I first became a Black-Belt-in-Training, a wise person (now my MBB) told me it was all about relationships. I didn’t agree at the time – it was all about the DMAIC techniques, obviously! – but now I have come to understand that the relationships we build with our teams will determine the outcome far more than what tool we use.

    That’s the foundation I try to build when I start to work with a team. It’s a lot more challenging when I’m doing Rapid Improvement Events and have only a few planning meetings before we go into the week-long RIE, but team members have to feel that they are the drivers of change, not me. If I can lead them to that realization of ownership, it’s a shorter step to getting them to realize that the "what’s in it for me" is not necessarily "less work for me" but validation of the reason they chose healthcare in the first place.

    Of course, if they aren’t there to help patients (directly or indirectly) then they should be invited to leave by a management team who puts patient care first as a conscious and continuing value!

  4. Kevin Norman

    Another "factor" I’ve seen that drives people to be"Kings and Queens" is that those people are normally rewarded for that capability ("Go to person", "Makes it happen", "Takes care of the customer",…). They are the best Firefighters! Also, the best Arsonist! Key to making the new processes stick is to figure out what was driving the old processes (there are always some forces and functions that mold a process) and change them to fit the new process and "punish" the old one.

  5. Sue Kozlowski

    Thanks Kevin, I think you’ve touched on an important point – the satisfaction it gives some people to be the go-to person. As a reformed over-achiever myself, I was always proud to hear "let’s give it to Sue, she’ll be able to do-to or fix-it." Nowadays I’m much more likely to say, "what’s the most effective way to do this?" which is not necessarily to rely on myself or other go-to person (the concept of "standard work" crops up frequently!).

    Also the point that the best Firefighters are also in the best position (if they so choose) to be the best Arsonists – their desire to be needed can be seriously challenged with a standard process that doesn’t include them. A good thing to keep in mind when setting up project teams – include these people; they start our being resistant but what a great source of knowledge if we can expand their concept of WIIFM (what’s in it for me)!

    Thanks again for your comments.


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