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The Story of an Organization and Their Struggle to Achieve Operational Efficiency


Last fall, I arrived at a client hospital site and felt as though I had fallen into the land of Winnie the Pooh.  The manager of the department seemed to focus only on patient privacy issues, very similar to Pooh with his honey. Her faithful sidekick, like Piglet, wanted everyone to like her in spite of job performance.  The clerk was like Rabbit and knew everything–just ask her; she’d tell you.  The quality control person was like Owl.  He spoke over everyone’s head yet seemed totally oblivious to it.  Eeyore was represented by a man who tried hard to convince you that the hospital was going to have to close because there were so many problems.  Kanga and Roo were represented by the mother/daughter team that seemed to be joined at the hip—anytime you saw one of them, the other was close by. (Did I mention that they didn’t even work in the same department?) The chief financial officer was Tigger reincarnated.  He was jumping everywhere trying to fix everything but would jump to the next crisis before he got the current one settled. It truly seemed as though the characters of the Hundred Acre Wood had taken a field trip to a community hospital on the west coast. What a mess!

My presence as a business strategy consultant had been requested to assess the chaos described above.  The hospital had recently gone through a business software implementation that moved them from a paper based record to an electronic health record. It unfortunately had not been organized well from the beginning, resulting in stacks of paper waiting everywhere to be scanned.  Doctors were angry about not having access to information.  Nurses were hiding the patient records to keep from having them get lost in the health information management department.  Revenue had slowed to a crawl because the billers did not understand the system well enough to drop bills when and if the chart made it through the coding process. So the coping mechanism for many of the staff had become something similar to reading the A.A. Milne stories of Winnie the Pooh and friends.  So, what would Christopher Robin do in such circumstances?  He would roll up his sleeves and get to work!

When there is a situation that seems like a hopeless, chaotic mess, I apply strategic thinking to the process:

  1. Categorize the areas of chaos into people, processes, and technology.
  2. Take emotion out of the equation.
  3. Talk to the people that actually do the job.  Unfortunately, too many times members of the executive leadership stop at the supervisory level without actually talking to the experts on the matter.  These are people that do the job, know the problem areas, and usually have a solution.
  4. Identify what processes are broken before assuming that the people are slackers. Separate training issues and processes that need to be documented.
  5. Only change technology after asking specific questions of the current systems – manual or electronic. Many times a business software implementation is completely successful from the IT or vendor perspective, but unfortunately doesn’t work operationally.  The systems around the technology should also be considered prior to buying and deploying.
  6. Hiring an outside management consultant is always an option, but it can also feed the frenzy if they don’t ask the appropriate people the right questions. Many times the internal people have the answers but they need someone to ask the right questions to draw those answers out.

It is up to the executive leadership team to make sure their team of people has the resources to do their jobs. If you are being Tigger, then you aren’t leading in a constructive manner for the organization.  You may be funny and cute to watch, but you aren’t helping the situation. Pooh needs a leader than can keep order so he doesn’t lose focus and immediately start for the honey jar.  Piglet just wants to be heard.  He may be liked by everyone, but he is truly interested in doing the right thing. Find Rabbit’s strengths and put those to work instead of allowing him to create stress among his colleagues. There is always going to be an Eeyore.  Use him to identify the roadblocks, and use that knowledge proactively. Make sure that Kanga and Roo have their designated new duties so they stay in their own departments managing their own duties. Many times it isn’t that employees don’t want to do the right thing.  It’s just that leadership hasn’t created the climate for their success.  In this hospital example, the chief financial officer needed to establish the environment for the right people and processes in the right place at the right time.  Will it be easy?  No, but Christopher Robin never walked away from an adventure!


1 Comment

  • Liisa Pursiheimo-Marcks August 10, 2010 at 4:09 pm

    Having implemented HR systems, I totally agree that the fundamentals must be in place before the system can work. My mantra is 1. philosophy – 2. process – 3. system. What are the guiding principles behind all decisions? How does the work flow? Once the organization knows answers to these questions, the electronic system can make everything faster. Without the answers, it may be faster – chaos.

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