Sunday, October 28, 2007

Sunday Scribblings #24 - Hospitals

Yo ho ho.
Hospitals make me laugh.
Not a joyful laugh,
but a cynical "can-you-believe-the-gall" laugh.
From the inside there's lots to see.
Layered with waste.
Much talk with little action.
Lots of ego and minimal consciousness about the incompetence.
(If you at least know you're incompetent, that's a step in the right direction!).

The "marriage" happened in 1998.
Not a love marriage, but an arranged hospital marriage.
An amalgamation that swallowed our autonomy.
"Saving money" meant creating more layers.
More management.
Endless cab rides from one site to another.
Costing tax-payers, not to mention the environment.

I've since seen hospitals go through "divorces", taking back their independence.
We never got that far.
We just got trapped in a bad marriage.
Helpless, and unable to leave.

S.M.A.R.T. goals


We are having our 3rd day-long workshop about how to make a goal SMART.
There are work groups that study and present this.
Don't get me wrong, I think it's important, because then we can measure our effectiveness.

The hospital has spent about $20k to teach us this stuff
(it's not really that difficult of a concept to grasp, but some of the therapists are a little resistant to change).
Even though they've dropped 20 grand into SMART goal training they won't pay the $1680 to teach us all CPR.
We have to pay out of pocket for that.

We work in a rehab hospital, for god's sake. Where people are sick likely to need CPR.
It is a requirement of our jobs that we have it. But they won't pay for it.
And they won't let us have CPR drills either, yet we have fire drills practically once a week.
Let the place burn down - we'll know what to do.
But god forbid you need CPR at our hospital.
Thank the lord I have malpractice insurance, cuz you never know when someone is going to pass out in the middle of a speech-therapy session.

I'm sitting at our weekly "team meeting".
Our agenda says that we're going to talk about the bulletin board in the lobby.
But that's the last agenda item, so I assume that means it's the least important.

I see "Waiting List" near the top of the agenda, and am anxious to talk about how we're going to tackle our mammoth ever-growing wait-list. It's been multiplying since those two therapists went on parental leave and they weren't replaced.
Bitching about what is allowed to be posted on the bulletin board and who is going to police it seems less important than figuring out how we're going to schedule new patients.
For 45 minutes, a bulletin board debate ensues.
Nonsense like "what goes on the board must be in line with our core values", and "what kind of stamp-of-approval" will go on posted items?" is spurted across the table.
We never do end up making a decision.

So now, there's no time to talk about the waiting list.
Out of this comes a "work group" whose job it is to figure this issue out.
They will meet, come back with recommendations, and the whole team will then debate and likely disagree with their recommendations.
That or the action plan will be veto'ed by the higher ups.

A hospital is a business.
With something to prove.
It still surprises me that they compete with one another
to be recognized as "the best".
There are score cards, things to measure up to.
Tracks to cover.
T's to cross and I's to dot.
Things to write down on paper and later forget about.

Every day we keep stats.
Stats about who we've seen, what we've been doing.
Stats that account for every minute of our day.
How much face to face time we're spending with patients.
How much "non-patient-care" time we log.
Good things to know.
Useful information.
Although it's a pain, I think it's a good idea to keep stats.

But then one day I learn that NO ONE looks at them.
That's right, they never get looked at.
We spend all this time meticulously recording our every move, and NO ONE uses this information.
Decades of data are ignored.
I thought our funding or salaries or capital budgets were calculated by our stats.
Seems it's all arbitrary.

No recycling at my rehab hospital.
I take my paper and recyclables home by the armful.
Still no recycling.
Still no recycling.
Plastic water bottles (distributed because of the lead in
the pipes).
Tons. LIterally tons of landfill.
Created by

I know too much.
This omniscient institution with too much yang pumping through it's infrastructure is a little messed up.

But the pension plan is pretty good... : )


  1. Oh. I know this. Hospitals are like little cities, little countries. Big waste, big craziness and not so much honesty. Great post! I admire your writing and your outlook!

  2. I hear you. There are far too many organizations like yours who have had their mission derailed in the name of efficiency and profit.

    "You can meet or you can work" is something I heard a while back and I spend much more of my time meeting than working. I do it in the hopes that the rest of my team will get more done since at least THEY don't have many meetings to go to.

    I also can only hope that eventually I (and you) will outlast the ones getting in the way of the real mission.