Sensitivity to operations II

Daved Vanstralen • October 12, 2013

Further comments from operational experience with "Sensitivity to operations."

In the hospital I would sometimes ask a resident physician to contact the hospital administrator-on-call or a medical consultant. The person often responds with "What can they do?" My counter response was, "If I knew, I would do it myself." This is part of a complex system. It suppresses the drive to ask for assistance. Is this the antithesis of sensitivity to operations?

The following is an example of such a query:

The Emergency Department physician caring for a child critically ill and deteriorating requested transfer of the child to the pediatric intensive care unit. The parents were Jehovah’s Witnesses and refused to grant permission to transfer unless we could guarantee no blood transfusion. By law physicians could have transfused in life-threatening situations without a parent’s permission (in fact, for minors they have a legal duty to transfuse). Sometimes the wisest use of power is the decision not to use it. I called the hospital administrator on call who calmed the family, explaining procedures. The parents then allowed transfer of the child. I had no idea how the administrator would fix the problem when I made the request but I knew that my involvement, as treating physician, would become sidetracked with administrative and legal issues regarding transfusion. In this particular case there was little likelihood of a transfusion but it was a major concern of the parents. The administrator was very sensitive to the complexity of the situation, calming and reassuring the parents. We made the transfer and the hospital stay went smoothly.

For information flow, what kind of assistance do you have to escalate information flow? How do you create a system that allows escalation of information flow without overtaxing the system? Information cannot get to the CEO for every issue. We cannot communicate linearly for everything. Sometimes you have to skip layers, but how do you manage this without breaking down the system? We need a workable system that works when you need it.

If I have a question, I have to be sensitive that the resources I am drawing are not available to the rest of the organization.

In the ICU, people are going to try to make sense out what is going on in an alien environment experiencing things they never thought possible. If I did not guide sensemaking, the family will create their own, often with assistance from people having even less knowledge and experience. The sensemaking I guided them toward had to take into account the ICU, the healthcare team, extended family and friends, and other issues specific to the parents.

How do we give feedback during the operation when things are not working? My experience in healthcare is that superiors do not like to receive disconfirming evidence – bad news. For those operating at a high level of sensitivity to operations they wanted bad news, as that was their guide for further operations.

Sensitivity to operations should be compared to planning and strategy making (not always the key activities). We need to be in contact with what is going on right now rather than how far we have deviated from the plan.

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Anxiety, Engagement, and Structure

By Daved Vanstralen • October 13, 2013

Engagement to solve problems creates High Reliability Organizing; withdrawal from the situation toward structure (rules and principles) or authority may be an anxiety response to uncertainty and threat.