Another nurse said three words to me that are the three words that most emergency physicians I know dread. Others in medicine dread them as well, but there's something particular about emergency medicine because we see patients so fleetingly.
Do you remember that patient you sent home, she asked matter of factly? She's back, and she's near death.
I was having a chat with this senior political adviser guy one time when he breaks out this story about an interview he'd done with a reporter.
This guy, he's built businesses, advised leaders at all three levels of government - he's one of those go-to types with high-brow networks the likes of which most people will can't even fathom.
Back to the interview. It wasn't going well, the guy told me; for whatever reason, the reporter, a woman in her 30s, seemed to have a dislike for him. He couldn't place it. It wasn't until after the interview was over that he found out what was up.
"You don't remember me, do you?" the reporter asked.
"Um, no, why, should I?" the guy queried back.
"I worked for you for years. Then you fired me."
The moral of the story, according to the consultant, was that he's always happy to see people who'd worked for him succeed doing whatever else. That was his takeaway. I asked him how the story turned out; he rolled his eyes and, essentially, said that reporters will write what they want to write regardless.
That story stuck with me. It reminded me of the countless, hard-working staff I know that engage tirelessly in political work during and between elections. It reminds me of the countless "faceless bureaucrats" who toil away, considered little more than cogs in the wheel by many of those who work above them.
There are reports about how this faceless, black-hole culture is a massive problem impeding efficacy in our public sector. The same holds true for countless private sector corporations, too. I once did a time-audit of a consultancy that makes ridiculous amounts of money, but has ridiculously poor internal organization.
It turned out that, by improperly aligning internal work schedules and a boss culture that felt meeting times were flexible for them (but not their staff), tens of thousands of billable hours were being lost. A high price to pay for being too busy (or too important) for your staff.
Money isn't the only thing that gets lost when managers don't take their teams seriously.
One service I offer (currently through Wakata Inc, if you're interested) is internal/external organizational management; making sure that work flow, responsibility, communication, transition and knowledge transfer are all properly designed for efficiency and maximum value add. My area of particular interest are smaller organizations that otherwise wouldn't have the resource capacity to get organized themselves (being too busy).
What find, consistently, is that where staff turnover is taken for granted (often leading to a focus on lower-wage labour and less training), important institutional memory gets lost without its loss even being recognized. New staff will develop their own filing systems, ignoring old ones they don't understand, only to abandon their work when they get rotated out and someone else gets rotated in.
When managers take a "someone has to bell the cat" attitude - essentially, putting leadership responsibility on low-wage staff without giving them official mandates as such - they will repeatedly get upset at new staff unable to meet the unclear expectations set by the person in charge. It becomes clear to these managers what the problem is - a lessening quality of staff. If it weren't for inept staff, their lives and works would be so much easier.
And the problem only deepens.
I've seen a lot of small Not-For-Profits that do important work fold because they simply didn't have the resources or managerial capacity to get past the moment or, quite frankly, because the people at the top couldn't get over themselves. These services disappear and don't get replaced, meaning more and more people of the people who relied on these services - battered women, new Canadians, youth with mental illness, etc. - go without.
Meanwhile, more cracks are showing in the services being offered by the public sector. More blame is being placed on "entitled" front-line staff or the odd Minister or Administrator who double-dips or under-produces, but the focus is always on the individual - get rid of them, put greater restrictions on their replacements and carry on.
This brings us back to Brian Goldman's example. A busy doctor - too busy and mentally over-saturated to keep track of every single patient made an avoidable mistake and a patient died. Could he have done something? Could he have saved her life, if he hadn't rushed her out the door? What of the second patient - what if Goldman had taken the time to talk with that patient a little more, come to understand the nature of his ailment a bit better?
Goldman is a doctor in a culture that is all about churn - working through a massive patient flow as quickly as possible, seeing as many people as possible. He has no control over that culture.
My friend the senior consultant guy is not a doctor; what he does is high-level, has no impact on the direct lives of individuals, right? He's a businessman making money, period.
The people he works with are policy makers - their job isn't to get into the weeds, either; they're too busy for that. Their job is to make efficient, cost-effective policy at the high-level and punt implementation responsibility down the chain. When something goes wrong, well, blame is one of those things that rolls downhill.
I know countless people like my friend who are "too busy" to engage with their teams - they expect their staff to come to them, full of piss and vinegar, or go out and find them on the golf links.
They are the bosses.
These are the people who define the cultures of our emergency rooms, our service centres and, where it comes to managers, our work cultures.
When the people in charge don't recognize the value of taking the time to know their teams, to respect their teams as individuals rather than assets, they are weakening the strength of their own institutions.
Perhaps there's a lesson in this worth remembering.