The Best of Times...

I have not had much time to read, much less write any blogs recently. Needless to say, my current job is much more challenging than the last one.

The environment is dysfunctional, but more to the point, it is more dysfunctional than the average clinic, family or corporate entity. A series of chief executives and turnover amongst the leadership have left the ship somewhat rudderless. The current CEO has made some much-needed changes, but only time will tell if it was too little too late, or if it was too much too soon.

My favorite Master's course was "Organizational Behavior." Organizations have a life of their own and no leader -- not even a command-and-control CEO -- can ever hope to really control a situation. Organizations self-organize and old dynamics are hard to change, even when individuals are fired, quit or move on.

I remember one situation with two people in adjoining offices who were always bickering. The two departments had no overlapping areas of responsibility and there was no structural reason to think that they could be at odds. These two just bickered.

One got sick and was replaced. The two offices still had problems working together. The other was transfered to another job in another building on campus. They still bickered. The boss decided to try replacing them both at the same time, but there was something in the air that kept the two offices in conflict. Perhaps it was a sort of homeopathic molecular memory, or the subtle expectations of all the other co-workers, or just the simple fact that all self-organizing systems have informal mechanisms for establishing organizational memory.

In all this administrative chaos, there is one constant; everything is driven by what happens when a medical practitioner closes the door and provides a medical service to a patient. Strangely enough, in the midst of a very dysfunctional and difficult environment, we are still seeing patients. Morale could be better, but I cannot discern any deterioration in the level of care. Our partners are nervous, but there does not appear to be any impact on the floor.

There are appropriate responses to dysfunctional environments. I would argue that this is the environment where change must come fast and furious. Sometimes it is better to make a break with the past than deal with incremental improvements. Part of evaluating the environment is determining how insecure everyone is because prolonging uncertainty makes people more insecure rather than confident.

I will elaborate more after this weekend's wedding in Sacramento. Time to break out the ouzo. I really need it!