DOING THINGS RIGHT; DOING THE RIGHT THINGS
I’ve been watching Season 1 of New Amsterdam on Netflix. This medical drama follows the inspiring Dr. Max Goodwin (Ryan Eggold), the new medical director at the oldest public hospital in America. As well as the usual patient stories, the drama centres around a high commitment to patients including uninsured people, his disrupting the system, his empowering his staff (with the exception of all of those he fired in the first episode!), and his own challenges, not least of which is that he has cancer. If you like drama that leaves you lumpy-throated after every episode, this is for you!
I’ve just watched episode 11 which included a story about an alcoholic homeless man who had ‘cost’ the hospital $1.4m in just a year by constantly checking himself in with a variety of phantom ailments. It was estimated that he’d likely cost the hospital $1.4m next year too. The medical director’s outside-the-box solution was for the hospital to rent him an apartment – “I’m prescribing you a home”. However that didn’t work quite as intended as the very next day he was back in a hospital bed, as lonely as ever. What next? Well, it turned out all his unnecessary stays at the hospital had granted him a profound knowledge of its layout, so what else? The medical director gave him a job in the hospital where that knowledge could be used.
Maybe a little unlikely, but this got me thinking about the old mantra "management is doing things right; Leadership is doing the right things". This quote is widely attributed to the late Peter Drucker the Austrian-American management consulting educator; I particularly like the work of Peter Drucker because his interests went beyond corporates and included government agencies and NGOs.
From this episode, individually all of the doctors had repeatedly done things right. This patient had presented with symptoms and they examined him each time, took a history, ran a series of tests, and formed a diagnosis. Their response to each individual presentation could not be faulted. However, despite the $1.4m expenditure, this man’s had received no actual treatment, and his physical health was no better now than it had been before. In contrast, the hero of our drama showed leadership and did the right things and in the process improved the quality of this man’s life considerable and also saved almost $1.4m annually, be it that his initial solution to just give him an apartment was by itself perhaps rather naive.
So do we see this playing out in OOHC?
Doing things right and doing the right things: Undoubtedly there are some teams and organisations who are “doing things right” and ‘doing the right things’. With a strong learning orientation and informed by both evidence and the experience of themselves and others, their quality services adapt to meet changing need and/or their growing understanding of that need and how children young people and families individually and collectively can be more effectively engaged, supported and meaningfully helped over time.
Doing things right but not necessarily the right things: Some teams and organisations are “doing things right’ and meeting day-to-day quality standards. However, as we come to learn more and more, both quantitatively and qualitatively, about OOHC outcomes, it’s becoming increasingly apparent that they are not making the kind of difference to people’s lives that they long-thought that they did. Their collective efforts are falling short, sometimes far short, of more explicit long-term expectations.
Trying to do the right things but not doing things right: This is usually where the organisation has a change in direction, but there’s a disconnect between the strategy development process and operational implementation. It could just be a professional development issue which some webinars, masterclasses or training workshops can solve. Or it could be that due to limited operational input the strategy is not actually very workable and needs to be changed (or abandoned altogether). More likely, it’ll be about trust, a feared loss of autonomy, workload, competing priorities, and the need for better implementation support.
Just not doing things right: The immediate priority for some teams and organisations just needs to be on ‘doing things right’. Those things are likely clearly understood with appropriate policies and processes in place. These teams and organisations need support and accountability to do these things much better. This is particularly important in teams and organisations where there continue to be reports that children and young people in OOHC are being abused or neglected, and that safety and basic quality standards are not being met. Some of these teams and organisations may even structurally mirror the responses to long-term trauma that we see with our children, young people and families.
Do you recognise your team or organisation in any of the above?