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Silo Working
The longer I stay here the more insane I realise things are
at the hospital. Once you start to learn how the place is run, its like peeking
behind the scenes at a magic show, only to find that the magician is drunk, the
doves are actually 3 toed pigeons with a severe case of mange, and the
'assistant' is just some homeless guy who wandered in off the street, but
somehow, they’re still saving lives…well…some lives. I have a whole new
appreciation for the NHS, it may be, as a consultant from Canada once told me,
like a football team with 3 players and 14 managers, but at least we have
managers who know what the procedures are for running the place, and care
enough to enforce them. Here, people just seem to do what every tickles their
fancy on any given day.
Over the past 3 months my biggest achievement here has been
getting staff to follow the already existing protocols of the hospital. I am
sure that this will produce a larger benefit than any new system I might bring in.
The hospital actually has a lot of good policies, the problem is most staff
don’t know they exist. It seems that everyone works in silos. A department will
form a committee aimed at targeting a particular problem, take great care and
time in come up with some great plans and policies, but then that’s it. After
that, as far as they are concerned, the job is done, case closed. It might get
written into a SOP (systems operational procedures) but as far as I can tell,
these are not enforced, not disseminated to staff, there not even all located
in one place. You have to ask the right person to learn about their existence,
and the right person is never who you think it’s going to be. For example, the chief
medical officer, who is responsible for all the doctors, the lab, radiology and
pharmacy, has no idea what’s going on. However the infection control officer
has an encyclopaedic knowledge of the policies for ICU, the QI officer knows
maternity like the back of her hand, and the guy who stocks the shelves in
pharmacy, knows all their policies, protocols and previously abandoned projects.
In true silo fashion, I am constantly talking to staff who
will be complaining to me about something, saying people are not doing this
right, or this new plan will never work because of that. When I ask if they
have raised this point with anyone who can effect any degree of change on the
issue, they look at me as if I have just asked them to preform open heard
surgery with a butter knife. Silly me, why on earth would you want to share
what you know with others. Best just take it to your grave.
The other maddening thing about here, is when I discovered these
long lost perfect policy, and I ask staff who are aware of them why they are no
longer followed, they smile at me sweetly, giggle, look away and then just
carry on with their work. Every single time! I have to become like the Gestapo,
hitting them with question after question, repeating myself endless until
eventually I get almost an answer, a half answer, maybe, if you read between
the lines, it might just be an answer. Mostly
they tell me there is no reason the rules are not followed and then imply its
because they all realised if they stopped following the protocol it made the
job quicker and nobody every called them out on it (to their face at least). I
once asked a head of department why they don’t enforce the policies or SOPs
they have and they told me that wasn’t their job, that everyone should just do
what they are supposed to do.
When I tell people I meet that I work at Maluti, they all talk so highly of it. People from Lesotho feel like its one of the best hospitals around. Given what I’ve witnessed, I really couldn’t understand why. But then I asked people what makes it so good. They told me its because people at Maluti actually turn up to do their job. In other hospitals you might go to get an Xray only to find no one working there as the employed for the day took leave without telling anyone and nobody is quite sure when they will be back, and this will be repeated in every department. At least in Maluti the Xray technician will be in to take a beautiful Xray for you, only to then be forced to take a blurred low quality picture of it on their phone and send it for review by the doctor via WhatsApp as the HD image can’t be saved anywhere.
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