Normalizing Dysfunction.

I recently accompanied a family member to the Emergency Room (ER). They completed the intake process by running tests, drawing blood and collecting vitals. Then we waited. And waited. And waited. And... waited, along with countless others. Some patients were slouched in chairs in deep sleep, others pacing, like me. I asked the nurses and triage staff several times for updates on when my family member would be seen, only to be told at one point there were nine people ahead of us. As the hours continued to pass, the same nine people were still ahead of us. I was totally confused. How was it possible that no one moved to the next phase of care?

Tired and weary after twelve hours without being seen (you read that correctly!), I expressed my frustration and asked the triage person for an explanation. I was finally told that the delay in moving patients from the ER to being evaluated by a doctor was due to the number of rooms allocated for emergency services. Those rooms were far less than the volume of patients coming into the ER and that until a patient was discharged from one of those rooms, patients in the waiting room could not be moved to an evaluation room. But the part that shocked me most was being told that it could take - wait for it - another THIRTY hours before my family member would be seen! I thought my eyes were going to jump out of my head. Even though the triage person was sweet and very apologetic, there was something so cavalier about the statement. Earlier in the evening when I asked another nurse about the estimated wait time, she told me some patients have been in the ER for twenty-four hours! That too, was a bit cavalier in a moment of crisis. Both were essentially letting me know that this happens all the time and "there was nothing they could do." We were concerned enough about my loved one's health to have stayed as long as we did but it wasn't a dire situation so we finally decided to leave, with test results in hand and a plan for a follow up primary care visit.

While I can't fix the breakdown at that hospital and whatever other issues may be at play that contributed to such a taxing experience for us and every other patient there, the entire ordeal made me reflect on this question: Have organizations normalized dysfunction to the point that it has become an accepted norm?

In many cases there are known challenges in the workplace that cause distress, lack of motivation, decreased productivity, low morale, high attrition, and more. When these challenges are ignored, it promotes a culture of distrust and perpetuates dysfunction just like my ER experience. On the other hand, there are unknown issues that are never brought to light because safe space cultures have not been established for employees to share concerns, get support and reach solutions. This is the undercurrent of dysfunction that can also lead to the same challenges previously mentioned.

Here are some questions to think about:

1. In what ways is your organization or team like the ER?
2. What feedback is circulating about your ER-like culture?
3. What do you do with the feedback?
4. Do you have a safe and confidential process for employees to share grievances?
5. How are those grievances resolved?
6. Do you assume there are no problems or issues if people aren't talking about them?

If you struggle with answering any of these, it's probably a sign to focus on exploring them with more thought, intention and commitment.

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