Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.
"But fire when it is smothered changes into acrid smoke that suffocates as it spreads." (Richard Wilhelm, The I Ching)
Why do we need a place to say these things about work to one another? Because issues that are brought up in context are smothered....this blog is the acrid smoke that spreads...my personal hope is that it spreads and eventually suffocates bad management.
Management here doesn't want to solve problems...it wants them to go away.
If staff complains about incompetent, even dangerously negligent Doctors or social workers or whatever, the solution is seen as "stopping the complaints" instead of "firing the Doctor".
To solve the problem of staff shortages, any live body that presents in the hiring que is hired to fill the spot...never mind that the live body is not qualified, burdens the existing staff, and will be unable to perform the actual job duties...if it's cheap and available, it's a go.
If the problem is "too many seclusions", the solution is to make the paperwork so onerous that people will avoid it, regardless of the situation. If the problem is "too many elopements", the solution is to make the fences higher, thicker, stronger. If the problem is conflict between coworkers, the solution is to ignore it until it goes away.
In fact, the solution to most problems is, apparently, ignore it and it will go away.
The management process here appears to be attendance at a series of meetings. From a line staff perspective, it is unknown what actually goes on at these meetings, but there are a lot of them and the people who attend them are earning relatively large salaries. Whatever it is that goes on there, it doesn't seem to have much to do with what's really happening on the front line of the hospital. I remember, for example, a few years ago when a JCHO visit was looming and apparently JCHO had brought up some issue about the temperatures in the refrigerators on the units. I'm working on a day shift, I look up to see an entire squadron of highly paid managers sweeping through the unit, approaching the unit refrigerator, and assessing its temperature. The amount of money in salaries alone that was present for this activity was mind boggeling..there were, I kid you not, 5 or 6 people there who's salaries were 60 to 100K (or perhaps more)...all looking at that refrigerator. This event was followed in due course by various forms and edicts about refrigerator temperatures, food storage, food dating, etc. Great. Certainly don't want to poison patients with old food....Yet at that time (and since) there had not been, to my knowledge, a single solitary case of food poisoning resulting from improper refrigerator temperatures or food storage techniques. There ARE things that happen that could (and do) negatively impact the health of patients or staff...but those things...the real, important things...are either smothered or ignored.
Good people can watch bad things happen for only so long before they need to talk about them. There's no time to talk about these things at work...during that time, we are working (...those of us who aren't in meetings all day, that is...)If we bring things up in "supervision" we are consoled, patted on the head, or threatened until we stop bringing them up. Problem solved.
...Except for the problem of really needing to talk about some of this stuff. So we talk about it here. Only by talking about the real problems can we hope to come up with real solutions. Good people don't like to collude in bad treatment; they want to make it better...that requires communication, mutual support, a real confrontation of the real problems. That's why we blog, n'est pas? I understand that there are some people who have a problem with this. I wonder why. What are they afraid of? Acrid smoke? A little fresh air generally fans the flames, disburses the smoke
They should blog about it, we'd be glad to help them.
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12 comments:
Real problems? Real solutions? Not in "Why We Blog".
I've enjoyed reading your blog, but it seems to be going downhill...falling into a deep pit of complaint and despair. You appear talented, possesed of a fine mind and sharp wit. You're obviously a concerned, caring individual. You seem frustrated by a system in which you are unable to accomplish the work which needs to be done; the work which you were hired to do.
Please don't let your blog become a useless litany of complaints, a pointless rail against management, yet another tedious tirade against "The Man".
Instead, give us the good with the bad. Describe real problems. Suggest or ask for real solutions. In short, give us back the clever, incisive wit revealed in your early posts.
Yes we did have at one time helpful supervison.......That was a very long time ago I think it might even have been in a differnt land .. Maybe that was OZ...Where things were working Or ....That is when the helm cared........ Now some teams don't even have Team meetings....How do you hve a team without a team meeting......Communication....What is up with that????/ Afraid of what the staff have to say?????
In your 3 rd paragraph you talk about the higher fence.....Are you aware of the 80 year old pine tree that was cut down due to someone climbing it to get out of the area?????? There have been a number of other trees cut down too..... And what ever happened to those ants did they buy an anteater??????
I am in agreement about trying to stay positive while doing what we do, which is work with and advocate for the mentally ill. Not that the system doesn't need fixing. We know that it does.
I'm still idealistic enough to believe that it starts with us, each and every one. You Gadde Fly are a true patient advocate. We need to remember why we're doing what we do. It's because these patients need us to care for them, respect them and sometimes speak for them. I'd love to hear more about solutions, positive aspects of working at the Madhouse, goood things that we do. And we need to quit using "FAT" as a qualifier. Next, we'll be saying "that Lesbian" or "black person" or whatever else identifies a staff member in some insulting, degrading way. It's a different story if said worker is doing a poor job in their position. Comment on that specifically but not about their eating habits. We're better than that.
Lastly, Gadde Fly, watch your butt. You're being watched very closely. Our great Chief Upstairs would like nothing more than to SHUT YOU DOWN. So please watch your "Identifiable patient information". To the rest of you BLOG ON...(just not on the state's computer system)
Dear Anonymous,
You know, when you're ALL anonymous, it's really hard to craft a response to the individual things you've said...just FYI, you can choose a moniker...and we still won't know who you are!! And it would make it a lot easier to answer you appropriately!
Thanks to all the commenters...and I want to reassure you - to whatever degree possible - that I'll try to avoid both a "useless litany of complaints" and "identifiable patient info"...Thanks for the warnings in both instances. It is hard to come up with solutions without the conversation...I certainly don't have any answers and depend on "anonymous" to provide data, perspective and ideas. I do think that there are two primary issues...one is that local management is negligent, inefficient and inept...the other is that the wider community is confused about values and what is in its own best interest.
It may be up to us, as the professionals, to lead the community in reasessing community values, but I think we're hampered by our local management. I don't know how to fix that...except through communication...through making the details known...sharing ideas, and so forth.
So everybody be careful...but remember Americans DO have the right to free speech...and free assembly...and the right to try to make things better...the only thing to fear is fear itself, right?
Blog On!!
g.f.
Dear GF,
I am not a member of the 'MadHouse"
but I do know many who are. I think it is very important to inform and share these stories with the public. We outside the walls care what is happening within them. I would love to hear any suggestion for management improvement anyone has. I beleive some of the problems mentioned here apply to the greater health industry.
Thanks,
And BLog On.
Hello!
I enjoyed reading the entries today. First of all, I totally agree with what some of the Anonymouses (Anonymi?) said about being patient advocates. At least for me, it's easy to get lost in the rules and paperwork and politics sometimes unless I boil things down to one simple question: "What's best for this patient at this time?"
Unfortunately, I believe Madhouse staff have to advocate for their patients even to the unit physicians. (Some of you might have missed my comments about a certain physician on The Assaultive Unit, since I only added them a couple days ago.) You should not *have* to pressure unit physicians to take care of their own patients, but until a certain physician is replaced, here's what I recommend. If you're worried about a patient, document in the chart: "Paged M.D. and requested that patient be physically evaluated for [sugar of 40, BP of 180, pulsox of 80, whatever]." If the physician fails to address the situation in a timely manner, notify the physician's supervisor and the nursing supervisor. Don't let physicians get away with ignoring their patients and life-threatening situations. After all, you spend more time with the patients than a physician does--trust your clinical instincts. And don't be afraid to ask physicians to explain why they're doing what they're doing--a caring doc wants staff to understand what's going because understanding the rationale improves patient care.
One of the reasons why I love the Madhouse is that most of the staff are deeply committed to providing excellent care to patients with severe mental illnesss. If you're on this site, you care enough to work for the solution, even if you have to work against physicians and administration to achieve it. BLOG ON AND ADVOCATE!
Thanks, M.ad D.og, for your very useful comment! This really helps, I think...I hope everyone will encourage those they work with to do as you suggest!! Remember, Annonimi (annonimouses?), that not everyone reads this, so you who do, be sure to pass this advice along!!
g.f.
P.S. Thanks, too to "Swamped"...glad to have the interest from outside the madhouse..and relieved to see both of you using monikers that allow for a more direct response!
Blog On!
I understand that this blog is getting some attention from some of the upper echelon in "the system". It is my hope that problems are finally recognized and solutions sought out. However, it's my experience that management will come together to have another meeting (most meetings seem to be the same members of management with a different committee name)to find a way to "extinguish" this outcry rather than find any true solutions. Let's identify issues for them. What are your top three? Good therapy? Safety? Salary? Qualified coworkers? It's time for provisions to be made for the Mental Health community AND their care providers. US.
This is a great idea, Cricket...I'd love to know what everyone's "top three" issues are. I hope people will do this...I think it might help us identify a "where to begin" in coming up with solutions...
OK. I'll start: my top three issues are:
1. A medical model approach has allowed (or caused) us to reliquish our clinical judgement to outside regulatory agencies.
I totally hate that.
2. There is a nearly total lack of recognition that the work of the hospital (it's actual purpose) is performed by the clinical staff who should (therefore) be accomodated in terms of schedule flexibility and salary, with an emphasis on retaining experienced staff in order to reduce the cost of training and orienting new employees. Clinical staff should be encouraged to use their creativity, their skills, their talents and training, to approach their work, their patients and their teams. The purpose of management should be to provide an environment in which robust teams flourish. It currently does not.
and 3. We are underfunded and have not made a convincing argument to the community that would cause it to want to increase funding. We need to be better marketers of our service.
So. What are yours?
Please blog.
g.f.
Well said, G.Fly! We are definately on the same page. I would like to comment on your first issue. Today a representative from a community mental health center came out to visit and discuss the disposition of a particular client that has been in the system for many years and has a very tragic history. The patient requires constant supervision for emotional and physical reasons. This patient representative is in touch with the client's needs and said that her boss erroneously wants to set this individual up in an apartment with a single round-the-clock caregiver. (We get worn out in eight hours with a handful of us working together with her.) That statement alone speaks to the fact that the decision maker, in this case, has no knowledge or hasn't had any contact with this individual. I don't have the answer, but I know when I see a situation is a setup for failure. If this dispo plan is put into place it will be detrimental for this client and the community. Why is an "external regulatory agency"
involved? Does it come back once again to the almighty dollar?
Yes! Why IS the decision maker someone who doesn't know the needs of the client?? And, what ARE the priorities upon which that decision maker makes his/her decision? And WHO decides who the decision maker is, anyway??? And why don't we know the answers to these questions? How can we do a good job with a patient when, in the end, the patients' dispo is completely out of our hands? How do you work with a patient who's being worked over by the "system"? We work in a context...we need to know just what that context is for treatment to be helpful. And, just guessing here, the "context" needs some revisionary work.
g.f.
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