Monday, June 7, 2010

Clinical microsystems and the lone champion

5 months of hardwork had paid off. Work in the laboratory medicine facility had become more streamlined, workflows better defined, the manager had better control and patients happy that they don't need to wait. All this with one less staff member. Patting myself on the back, I disappeared from the scene as there was not much for me to do.
A year later I walked into the same department and met with a sorry scene. The earlier chaos, long queues and dissatisfied technicians. The very things we got rid off. So what happened? The problem was in my approach. Assuming that complaining patients and problems with employees would be serious enough issue for upper management to keep the issue as priority, I did what was needed on the operational front. Optimize the systems and reach the objectives of the project which is make patients and employees happy and bring costs down. But I did not realise that as soon as the project went off the radar, the top people in higher management would forget about the circumstances and problems which led to the sorry state in the first place. And gradually the attitudes, the lack of understanding of the ground reality and the disconnect with the frontline came creeping back. No one noticed until the finely tuned system broke down again and business was back to normal. The middle managers who had changed in the meantime went back to doing what they knew to do in such situations I.e ask the employees to work harder and faster. The department head who supported my earlier effort was more a technical person than managerial. She really never understood how with her support we managed to turnaround the situation so she did not know how to deal with the 'recurrence'. Herein was the problem, there was no local change champion who would hold fort despite the external or internal pressures. These pressures can be strong and flow against the balance that is required to keep the system running smoothly.

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