The hospital at which I work is much more than just a building. It is a bureaucratic organization of interrelated statuses and roles stratified upon a hierarchy of authority and power coordinated to provide health care to our community. Most members of the community only see the end result. When they are sick or injured, they come to us and we care for them.
What the community doesn't see or see often is the corporate culture embraced by some elements of the organization. This culture is characterized by all the slap and tickle, buzzwords, and managerial guru crap popular in corporate culture these days. Some at my hospital are completely ga-ga for it.
Take for instance their newest corporate embrace, a program supposedly designed to "hardwire excellence," whatever that means. (Don't ask them, unless you want to be drowned in a sea of corporate cliches, 7 habits, and all those cool folks you're supposed to meet in heaven!)
The program is the infamous source of the low-middle-high performance assessment tool. And what a handy tool it is...for determining not so much the worth of employees as their allegiance to corporate authority and their willingness to agree with and align their own interests with managers and administration, even against their own ethics and best interests.
Fully 75% of the assessment tool in this program is subjective! Questions like, how much does this employee accept and support the decisions of his/her managers? How comfortable do I (the boss) feel when this employee is on shift? What is the attitude of the employee toward his/her workplace, manager, administration?
Now, if ours was a totalitarian organization, I could see where these questions might truly reflect the value of an employee. Or at least ferret out those who need to be eliminated. But, let's be honest, these questions have very little to do with how well an employee does his/her job!
Objective questions could do that, and would be easier to defend as a true performance assessment, while keeping the subjectivity of like and dislike out of it. Why wouldn't a health care organization that wants to provide quality nursing services be more interested in how well nurses perform rather than how well they mouth the words of the corporate line (for they really don't want nurses to say anything)?
One reason is that an assessment tool of objective criteria of nursing performance is harder to devise than one based on subjectivity. You can't really get it out of a guru's book, and I'm not sure that they are smart enough to do it themselves.
A second reason has more to do with the manner in which the subjective assessment tool can strike fear into the workplace of those who have it used capriciously against them (see the most recent two entries). No objective criteria to tell me I'm a bad nurse? Just tell me I have a negative attitude! That's a great reason to fire a good nurse, despite this era of nursing shortages.
Of course, as I mentioned in the last entry, the low-middle-high assessment tool is a one way street: those at the top evaluate those underneath them, and never have to be evaluated by them. That means, the top dog is the one whose attitude and belief system is what everyone else in the organization has to agree with or at least espouse, at least at work. But the top dog isn't the pope, doesn't wear a funny hate, and isn't infallible. Excellence hardwired doesn't seem to account much for that fact.
And, if you're not the top dog, don't go mentioning it; you'll be labeled a low-performer.
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3 comments:
Five out of six sequential sentences use the word "corporate."
Is that word more, or less precise than "hardwired excellence"?
Which five of six? (Just for clarification.)
In answer to your question, "hardwired excellence" may be a more precise term, as in a measure of a concept in narrow or minute mutually exclusive categories, but "corporate" is an accurate term, as in a measure at such a level which illustrates the gist of the concept being measured.
Precise measures are not always accurate (i.e., a clock that measures time in micro-seconds is no more accurate than a clock that measures time in days if both are set incorrectly) and accurate measures are not always precise (i.e., social class measured as low, middle, or upper might elucidate what a person means, but it is hardly a precise measure).
I chose the word "corporate" to suggest an orientation or way of thinking about the hospital that focuses more on business and business-like aspects of the organization and business-like approaches to management and administration. Some of these approaches approximate management "fads." Like WalMart calling cashiers and stockers "associates." Makes them feel good, but really, they're just cashiers and stockers.
In medical terms, my use of the term corporate is a gestalt thing.
I am curious if you have tried any of the tactics in the book? I have and would more say that it does focus on the patient and thus nursing. The wording is done in a way so that nurses can get buy in for behavior that impacts patient care.
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