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This past week I’ve spent every single evening in the hospital visiting my mother-in-law who recently broke her hip. For me a hospital is a scary place to visit—dredging up childhood images of needle pokings, haunting screeches, and indelicate probings of all kinds. My company’s recent research into the dangers of hospital professionals passing on diseases to their patients hasn’t exactly increased my comfort level in buildings sporting red crosses.
With these most recent trips to the hospital, I soon learned that my fears are well founded. Despite the loving attention that caring professionals gave to my mother-in-law, I found myself disturbed by what could easily be described as a “cry-wolf culture.” Attached to my mother-in-law were several devices that measured everything from her oxygen level to her heart rate to her medicine intake. Each device had an alarm, each alarm sounded regularly, and nobody but the patients and their family members seemed to give them a moment’s notice.
Eventually I mentioned to my mother-in-law’s respiratory therapist that nobody seemed to be too worried about all the warning beeps and clicks, and he immediately went off about how the stupid alarms were always going off every time a patient moved in the slightest. When he was at work he would wait as long as he could stand the warning alarm, hoping the device would finally reset itself or something—and this was when he was assigned to the intensive care unit. Obviously, most of the time the alarm sounds mean nothing, so after the machines cry wolf for a few minutes, people treat them as background noise.
Outside my mother-in-law’s hospital room you can find still another device that nobody cares about all that much. It’s a plastic pump bottle filled with antiseptic. A sign next to each door clearly states that employees are supposed to use the antiseptic—both entering and exiting the room. This way they won’t be passing diseases from patient to patient.
I’ve watched for hours on end as healthcare employees walked by the bottle without giving it so much as a glance. Occasionally someone would pump the bottle and rub his or her hands together for a second or two. The preferred method seems to be to treat the bottle as a religious icon. People just pat the top of it as if mere contact passes on some mystical healing power. Nobody applied the antiseptic and rubbed it in for the required fifteen seconds. Nobody.
Setting up rules and regulations that aren’t actually followed creates a culture of unpredictability and cynicism. When it comes to healthcare, patients lose faith. They figure that if granny is going to be safe, they’d better take matters into their own hands. And they do. When it comes to our granny, we have someone on watch most of the time.
Healthcare isn’t the villain here. All organizations can and routinely do make the same mistakes. Families do it all the time. Not ten minutes ago I watched as a mother threatened to abandon her toddler at the market as a way of getting her to follow. Would she really leave a three-year-old all by herself just to teach her a lesson? Of course not—and the kid knew it. Mom cried wolf and the toddler continued playing until mom eventually took her by the arm and pulled her back to the cart. It turns out the pulling was the actual alarm the kid paid attention to. Everything else didn’t matter.
Healthy organizations, including families, have certain admonitions that are religiously followed. For instance, you can read a whole host of parenting books that suggest that in successful families, “no means no.” It’s important to have a baseline you can trust. Now, before you run off and become a flaming authoritarian who always says and means “no,” I think this approach deserves an explanation—and this, by the way, is my personal interpretation. I don’t know what others have to say on the matter.
I think in healthy families, there are different kinds of “no”s and everyone understands the meaning of each. For instance, my granddaughter climbs on my lap and asks me to read a book I’ve read to her about a hundred times before, right in the middle of a telecast of the all-important New Zealand dart tossing semi-finals. I tell her no. She looks up with an innocent smile and says, “Please?” I read her the book.
Now, lest you call me a wimp, I want to make it clear that I didn’t chicken out or sell out. I came to my senses. I looked at my sweet granddaughter and realized that my original “no” was a bad idea and that it was okay to change my mind. That particular “no” didn’t mean “no.” It meant, “I don’t think so, but you have my permission to persuade me otherwise.”
But I also have a no that means “no.” In my case, a vein stands out in my forehead and my kids realize that their newly invented game of bouncing a baseball off my new sports car is coming to a halt or there’s going to be hell to pay. My wife has a far better tool. She raises her right eyebrow—and only her right eyebrow—and everyone knows that whatever she has just mandated and they have been so foolish as to ignore will now be followed to a tee. That’s her “no means no” sign. It’s subtle, nonviolent, and works like a charm.
Now, before I return to the hospital where no means “your guess is as good as mine,” let’s explore the other end of the continuum. This is the place where “no” does in fact mean “no,” but it’s based on some bureaucratic rule or policy. Such rules are created every time somebody does something costly or dangerous and then, instead of agreeing that the action was a one-off and will never happen again, or that it happens rarely and should be handled by the nearest leader, the powers that be pass a restrictive regulation that ties the hands of every single employee—often unnecessarily. We completely restrict the good and loyal rather than hold the oddball violator accountable.
For example, I once worked alongside thousands of dedicated volunteers who, among other things, drove cars owned by the company they served. Occasionally one of the eager volunteers would back up a company car and bump into a stump or something, costing the company a few hundred dollars in repairs. Finally, one of the big bosses came up with the perfect bureaucratic solution. The company now requires one volunteer to stand outside the car and wave his or her hands in helpful ways to guide the car so as not to back into a stump.
Guess what? Back-up accidents dropped. After all, these are eager volunteers. Guess what also happened? The people who are now standing outside waving their arms—sometimes in a snow storm—feel cold, and wet, and stupid. They think bad thoughts about the leaders who make them do such ridiculous things.
So, on the one hand we have important rules such as wash your hands before you clean a patient’s dressing. These are rules that we all agree make sense to follow all of the time. These are the rules that literally have life or death consequences. On the other hand, you have rules such as “stand outside and give directions to your colleague in an empty parking lot even though there isn’t anyone or anything behind you for a country mile.” These are rules that we all agree make no sense to follow at all, and potentially end up wasting time and resources.
The takeaway here is simple. Routinely examine your family or company rules, regulations, and policies. Which ones need to be followed religiously? There should be few if any. If you have any such important strictures, make sure people follow them all the time or you create a culture of wolf-crying alarmists and raging cynics.
Also realize that many rules are made to have exceptions. Develop respectful and clear ways of communicating your degree of seriousness.
Finally, look closely for rules that were made up out of anger because somebody once did something stupid and now there’s a very restrictive policy in place that needs to be rescinded. Rescind these mindless constraints or count on a continued disrespect for authority.
Oh yes, one last thing. Should you visit my mother-in-law in the hospital, use the antiseptic just outside the door—or my wife will give you the evil eyebrow. And you don’t want that.