Last week, I described how my experience aboard a floating casino started me thinking about the need to get past the prejudice of seeing only individuals in health care and the need to see them, occasionally, as numbers.
What makes the public health view so interesting is not just that it looks at people as numbers, but that it sees this as a good thing. As noted, this goes against the grain of most everything we've been taught over the years. Nonetheless, it is not only required for effective programming in public health, but seems to be a requisite skill for management.
I say this as someone who has absolutely no interest in agreeing with this proposition. When I took over as Director of the Volusia County Health Department (VCHD), I told myself that I would tailor my efforts to the talents, skills, attitudes and limitations of each individual member of our staff. I quickly learned that it was impossible to do so as leader of an agency with over 300 employees. I learned that one has to separate the person from the position and the name from the numbers, in order to make progress within an organization. I've come to realize that the ability to mentally turn people into numbers is an absolute job requirement of the effective manager whether in business, public health or EMS.
The change in my thought processes has been gradual, but it made me recognize that ascension into management is not merely a promotion. It's a totally different job. No longer are you supporting your work group, content to excel within your own branch. Suddenly you're compelled to look at the entire tree, fertilizing here, pruning there, until the organization continues to grow and flourish. I've found that you can't do that by focusing on individuals, tending to their needs in favor of the needs of the whole. To do their job properly, managers do often need to think of employees as numbers.
Here's a glimpse of what I mean. I have some employees who just aren't up to their job assignments. As people, they're all very nice, honest, decent human beings. I like being with them. But to get their jobs done often requires my intervention. That takes time from the things I need to be doing to move the organization forward in the community.
I like these people very much and have no desire to hurt them. But I also know that they're not helping us to grow. If I think of them as people, I can't move them along because I don't want to hurt them, despite how the organization may suffer. If I divorce myself from them as individuals and think of them as numbers, I can give them a chance to be in places where their talents might be better utilized (such as in a lower position internally or outside of the organization) and my agency has a renewed opportunity for progress.
I don't want to be taken the wrong way with this. The fact that managers sometimes need to look at their clients and employees as numbers in no way excuses loutish manners, gross incivility, rapacious profit-taking, unethical behavior or the need to accommodate the circumstances of the individual to the needs of the group. Indeed, the astute manager (or at least the one I'm striving to be) is required to identify the strengths and talents of his employees. He or she nurtures and develops their abilities as the whole moves ahead, providing a stable, energetic, mutually supportive and genuinely fun work environment. But to expect management to sacrifice the health of the organization for the circumstances of an employee is an unrealistic hope. And yet this is exactly what we, raised in a culture that puts the wants of the individual first, expect from our managers. And when they don't cater to us and instead make decisions that put the organization first, we brand them as evil, against the employee, heartless. We say they see us only as numbers. But I argue that, to some degree, that's exactly what they have to do.
Let me give you an abstract version of how the idea of thinking of employees as numbers works to the benefit of an organization. The VCHD recently brought in speakers to help us improve our interpersonal skills and deal with the prospect of corporate change. One of the lessons that stayed with me is the "20/50/30 Rule." In essence, this principle says that when change comes to an organization, 20% will favor it, 30% will oppose it, and 50% are "fence-sitters," the undecided voters who will probably go with whoever presents the best case.
If the leadership of the organization focuses on individuals, you're going to spend all your time dealing with the 30% of employees who avoid change. If you focus on the numbers, your efforts are directed toward the 70% who will come along with you. Doing so enhances the speed of change, improves operational efficiency and builds a team committed to similar goals.
By tailoring your programs and policies to meet the needs of those who can handle change, you don't limit yourself to merely preserving the past for the comfort of those clinging to outdated ways. Those who refuse to change will often leave the system because of their own discomfort with the new paradigms and drive for progress. Replacing those workers with those who accept change will decrease the ratio of those who will not embrace your vision. So by thinking of employees as numbers and "playing to the majority," as it were, you accomplish change faster than you would with a focus on the individual.
(The speakers gave us another useful tool that, to be honest, I'm still trying to figure out. This is called the "three-in-one" rule. For every negative statement you make to a colleague, you first mention three positive items. I'm not sure I can pull it off. I've been trying to find a way to say, "I really like working with you. You're a truly motivated and enthusiastic person. You have a great knowledge base. So where in the world did that bonehead idea come from?" Still working way my through this one.)
I think one of the problems in resolving this issue is that managers often claim they don't treat people like numbers, when in fact it's apparent that they do. As I've discussed, there's nothing wrong or evil in this approach; in fact, the view becomes more necessary the larger the organization. But the contradiction between word and action speaks of insincerity. I've found that there are right ways and wrong ways to explain why, as a manager, you think as you do. I've learned in medicine that, even when giving bad news, honesty usually works best.
So when I have to explain a downsizing, I try to give the affected employees the entire rationale behind it. When we can't hire new people to support overworked staff, I produce the budget figures to back my position. When someone's not performing well, I try to explain in detail what the problems are and develop a corrective plan to improve the employee s performance.
I'm nowhere near as good at this as I need to be, but I've found that employees respond positively to even the slightest attempt. I have a sense that one of the reasons most managers get a bad reputation is that they simply don't communicate "down the chain" the same way they do with their superiors. To some extent, I think the ethos of business has been to keep secrets rather than provide information. Perhaps I'm spoiled because I'm in public service and most of our information is in the public record, available to anyone who has the will to find it. But I still think that even in the private world, to be as open as possible is still the best policy. And we need to be honest about how managers often think of employees as numbers, and employees need to recognize that there is no inherent evil in this idea.
I'll finish this thought about how both public health and corporate managers may correctly view people as numbers with a note about outsourcing. This is obviously a hot topic in this election year. The export of jobs has been blamed for the fact that corporate profits and stock values keep rising while job growth lags far behind.
I think the key difference between "good" and "bad" outsourcing is the reason it's being done. If it's to ensure the survival of a company and the choice is between fewer domestic jobs or no jobs at all, you take the outsourcing. It's bad for the individual, but better for the system. That's thinking like a public health person. However, if outsourcing enhances the bankroll of a few rather than bolstering the company as a whole, that's unacceptable. And, strangely enough, that is also thinking like a public health professional.
Back to the casino
Fortunately, this complex thought process quickly passed, and it was over to the gaming tables. I played blackjack and roulette, which are the only games I understand. (I don't mind losing, but I need to know why I'm losing.) The slot machines, however, proved to be my downfall.
The cruise lasted six hours, or about two voyages on the SS Minnow (and with much less baggage judging by the fashion stylings of Ginger Grant and the Thurston Howell clan). If you don't gamble, this is about three hours too long. As the ship headed back to shore, we skipped up to the Las Vegas Lounge to enjoy music, dancing and further merriment.
Getting to the lounge itself was somewhat of a task because by this time the hallways and stairwells were occupied by sleeping passengers who didn't stir when the PA system asked them to clear the area. The Las Vegas Lounge was a coincidental name for the bar, for earlier in the evening I had learned that my friends Ron and Cherry Freeman had actually been married at the Graceland Wedding Chapel in Las Vegas. I was really impressed by this, for I had always had this thing about getting married by an Elvis impersonator. As I've grown older, I've tended to up the ante. I want to get married by a specific member of the pseudo-Elvi, namely Pol Parsley, the Thai Elvis. So not only can I get lines from Elvis songs in my next nuptial rituals, but I can hear them said in a foreign accent ("Luv huh tenda, let huh be yoo Teddy Beh, an dohn't be crool.").So the cruise ended, but not without some casino-induced thought and a little bit of understanding. While playing one of the slot machines, I cashed out my coins after losing a few bucks just because I wanted to hear the plink of nickels in the tray and carry them around in a big plastic cup. It didn't matter that it was only about half the nickels I started with. For just that moment, I felt like a winner.