Whose Job Is It, Anyway? (and Swiss cheese)

 

This week I have been working with a client who has high and exacting standards. They boldly put excellence on their website and marketing materials as one of their values.

 

However, under the surface, in some areas, there is little in common between their values and what happens in practice.

Standards are slipping, the team is beginning so signs of a high turnover of staff, management structure is resorting to a dictatorial approach, and the is a creeping feeling of despondency.

Some of the team are superb, great communicators, going above and beyond, always anticipating, planning, looking to make things better for everyone else not least the patients. Others are very different.

 

As I spend time in the practice listening, I was reminded of this little story

 

“Whose Job Is It, Anyway?”

This is a story about four people named Everybody, Somebody, Anybody and Nobody.

There was an important job to be done and Everybody was sure that Somebody would do it.

Anybody could have done it, but Nobody did it.

Somebody got angry, because it was Everybody’s job.

Everybody thought Anybody could do it, and Nobody realized that Everybody wouldn’t do it.

It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.

 

Does this sound familiar, do you notice any similarities to your place of work?

 Remember, a problem can only be present in absence of a truth-full conversation.

 

I invited the practice to define the journey their patients through the practice. Each step of the way clarifying, leaving no element of guesswork, who is responsible for each function and who is the back up?

We also discussed the Swiss cheese model of risk management.

A receptionist told us how they had had an angry patient call, incensed that a dentist had not returned the requested call.

When we unpacked the events, we realised that the dentist had tried to call and the number on the computer was incorrect. It transpired that the patient had been in several times and the number had not been updated.

The team recognised they needed to add more layers of cheese to stop the hazard. These included.

• Very clear and specific request for patients to check their personal details and medical history, rather than a casual “can you check this.” The reception team amend the details.
• The clinician asks the patient to confirm their personal details.
• The nurse is at the computer updating as the clinician is speaking with the patient, confidently asking for clarification where needed.
• When telephone calls come in the receptionist, confirms the number they want to be called back on.

This may seem like duplication, and we all have experienced busy practices and things being missed without malintent.  Multiple layers of systems and processes prevent the hazards getting through.

Where in your practice would these concepts be useful?