Sunday, 4 December 2016

BASIC DRESSING: THE MYTH OF MANAGEMENT (I)

The smiling woman has no intrinsic worth


After almost four decades of work, I have come away from the experience with what I believe is the answer as to why the West is apparently in a death spiral; management. Not management per se, management in and of itself. Management is necessary, to a certain degree and after a certain fashion. My two favourite managers were both middle-aged women, one in NHS Information, and for whom I later worked briefly as a medical librarian, and the other in the large sub-editing department of a lifestyle magazine when I drifted into production journalism. They both succeeded and inspired their staff by what you might call an unwillingness to impede. They simply assessed each staff member’s capabilities – in a refreshingly non-formal way, and encouraged them to make use of those abilities for the team and the end product. But this is far from being standard management practice, as we shall see.

I have worked for the NHS in four different capacities, and it was one of these positions that first gave me the notion that it was a certain management style that was to blame for the fact that, as we are constantly being told by the guardians of Traumaville, this venerable institution is on the brink of collapse. While we are on the subject, a worthwhile task for a real journalist would be to expose the scandal of NHS diversity officers, but don’t expect the Left-wing L├╝genpresse to be doing that any time soon. But I digress.

In 1990 I was faced with a quandary. Should I issue orders to begin the ground war in the Gulf or not? Just kidding. I was approaching the end of my funding to complete my Ph.D., and needed a job for a year, but not really any longer than that. One evening, in a bar at the UK's second largest hospital, I fell into conversation with a gentleman faced with a similar problem but from the other perspective.

The hospital, like all hospitals, had to have a constant supply of sterile supplies. As you are doubtless aware, you can’t wipe off a butter-knife and use it to whip out an appendix. From the needles used to sew up flesh wounds to the full silver tracheotomy pack, from the chiropodist’s nail-brush to super-sterile toilet bowls for HIV sufferers, everything used invasively or around an open-wounded or immune-compromised person cannot have a speck of anything on it.

The man needed a go-between both to order at a ward level and liaise with the Central Sterile Supplies Department at another hospital a few miles away. Once a system was in place, the job would just require a flunky who could unload a lorry and distribute boxes to wards and departments without getting a nosebleed. As mentioned, the man estimated that it would take about a year. Providence.

Day one, and I rolled in early and full of enthusiasm. I had carte blanche – or I thought then that I had - to establish a system to ensure the efficiency improved from the 45% mark at which I took over. By the time I left, a year later, it was 98% efficient, and management undoubtedly took the credit for this when I was no longer around to tell the truth. In fact, I succeeded despite management, not because of management.

I had a simple plan for the first day. I would visit every ward and unit and see whether there were any common problems I could prioritise. I didn’t have to wait long. By coincidence, I began my round in the Neo-Natal Unit and ended it in the Geriatric Ward. It felt like travelling through the entire life cycle. What the first day told me was that ward sisters and nurses had one common problem; the basic dressing pack.

The basic dressing pack is what it says it is. If you have ever gone to an A&E Department (ER in the States) with a bad cut or other wound, they will have used a basic dressing pack on you. It contained, then, needles, thread, absorbent pads, dressing, disinfectant and two balls of cotton wool. It was the latter that caused the problem.

Cotton wool is, as you know, made up of thousands of tiny strands of cotton, difficult to see and liable to separate. Cotton wool therefore has a tendency to ‘linting’ or leaving strands of itself behind which may not be easily visible. On the skin that isn’t a problem, but in an open wound which is then sutured, it will rot and can cause septicaemia. The sisters would have preferred Medigauze, which is not susceptible to linting.

These were pre-internet times, but I sat down with medical supplies catalogues and managed to find a basic dressing pack, with Medigauze, for less than the price of the current supplier. I wasted no time in cancelling the standing order and setting up a new one. Day one, and a palpable success. I didn’t have to wait long for the call.

These were also pre-mobile phone days, and the little pager I wore went off, displaying an internal number. I called it and found myself speaking to a man with one of those managerial titles you forget almost immediately because it doesn’t really mean anything. Could I come and see him?

After getting used to seeing nurses huddled in broom-cupboard-sized rooms as they handed over shifts, I was surprised to find this manager sitting regally in a spacious, sunlit, oak-lined office which could have doubled as a squash court. Our interview began, and I had the first of many lessons in the myth of management.

Apparently, I had changed the dressing pack supplier, he said smiling. Indeed I have, I said, producing the amended figures and projected annual saving. He gave me that look of simulated patience I have some to despise, the look they all give in the face of unscripted initiative. Was I aware, he asked, that I was supposed to consult the user group before making this type of change? Ha! I had him. I shot back that I had already consulted the user group, naively assuming that a group of people using the item in question was a user group. It was not. He meant the User Group, comprised as it was of more managers and cyphers who never came into contact with sick or injured people, but earned a good deal more than those who did. Right, I said. I’ll give them a call. I was then informed that a proposal would have to be put to the meeting of the User Group. The next was scheduled for a month hence.

My order remained unchanged on this occasion. The man who had hired me was senior to this buffoon in his giant office, and over-ruled him. But this was just the beginning of my many, many fights with senior management throughout a number of industries and capacities. I have learned that management exists largely to impede initiative, to take part in time-wasting exercises often disguised as ‘training’, to force those below them to duplicate their work needlessly in the writing of reports, to provide mis- dis- and non-information to those trying to work ‘below’ them, and otherwise to justify their existence and generous salary and pension by creating work for others to do. This toxic compound is particularly egregious in the public sector, but can also be found in the private sector, as we shall see when I get to property management, a breathtaking scam almost entirely supported by useless layers of incompetent and irrelevant management. This is the first in an occasional series to criticism of management. I hope it will help those unfortunate enough to have to put up with and work under this pestilence.

Finally, I’ll look at how corporate and public sector management is a microcosm of government, and how deliberate mismanagement operates at both levels and is entirely intentional.

In the meantime, should you be unfortunate to work under a line manager, team leader or other dim-witted appellation, do resist the impulse to kill them. I only just succeeded.

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