To Change or Not to Change

To Change or Not to Change

April 7, 2008

Introduction

In the world of large organizations there is a strong temptation to streamline operations by having blanket systems and procedures in place. This is intended to achieve a consistent end product or service, particularly if an organization has multiple locations providing similar services. McDonalds and Home Depot, as well as many other retail franchises are great examples of success in that area. You can go to any McDonalds in the country and expect to get the same Big Mac in the same amount of time with the same procedure for ordering, paying and receiving your food. This works well when the product is the same and when all other conditions and functions are the same.

The problems occur when those procedures are duplicated in environments which may appear to be the same from the outside, but with a closer look, are not the same at all. This can happen when decisions are made by upper management without real understanding of the significant differences which may be present between two similar departments. The rationalization for the duplication may be well intended, but far too often the underlying reasons are for the convenience of upper management to be able to view the organization without having to understand multiple procedures.

Our Organization and its Situation

I work as a respiratory therapist at the largest level-one trauma hospital in the most southeastern part of Tennessee. We are located in Chattanooga and serve 50 surrounding counties. The nearest hospitals with this level of service are in Nashville, (100 miles to the north), and in Atlanta, (130 miles to the south). Our hospital is divided into two distinct parts. The main hospital is for adults and then there is Children’s Hospital, which is a full service, self supporting hospital designed specifically to care for children. Children’s is where I work.

As with the hospital itself, the respiratory therapy departments also function separately from one another. This design is intended to offer the specialized care required for children, from neonates to adolescents. These two entities have been managed separately, until a recent change which has created the position of Director of Respiratory Therapy. This position is one which is over both the adult side and the children’s side. Certainly this decision of the board of directors was designed to create uniformity and a consistent set of policies and controls, which may lesson possible liabilities as well as find a way to combine services, which could eventually save the hospital money. Unfortunately, the consequences of this decision are just beginning to be felt.

The problem isn’t necessarily with the position as much as it is with the person in that position and her management style. This newly created director is the former manager of the adult side which is considerably larger, staffing 80 therapists while Children’s only has a staff of 24. She has come in making some understandable control changes such as processes for controlling the administration of medicine, ensuring all required employee training and testing are completed, which keep the staff in compliance with all regulations. These are all designed to lesson the chance of lawsuits and fines for the hospital, protecting their assets and reputation.

Unfortunately, she has gone beyond what should be her role, and has taken control of every aspect of department operations. While she has separate managers who are in charge of their respective areas, she has not given them the empowerment to manage those areas. Being the former manager of the larger adult operation, her opinion is Children’s should run identically. In fact, we are not the same and should not be expected to be the same.

We are specialized in the care of children, who have completely different needs than do adults. We take pride in our specialized field and have a great teamwork attitude in our department. We have the responsibilities of caring for the respiratory needs of teens, preteens, toddlers, infants, and premature babies. We do this in a variety of environments, which require a variety of specific skills and knowledge. The Neonatal Intensive Care Unit, (NICU), is very intense and requires the ability to care for and assess the needs of babies born many weeks premature, with severe respiratory problems and so small they can fit into the palm of your hand. We are required to be present at all child births.