When survival is the name of the game

Have you ever found that the ability to think or to be educated is a liability? An example is being trained as a doctor to do the latest ‘right thing’, to the latest standard, even to HIQA standards, and then you find yourself in a hospital or aged care facility, or within a new team. This team is stuck in another, older time zone, or a less-educated time zone, or it may just be that their standards have gone down over time.

‘Yes’, these staff say, ‘we all came here with high standards initially, but soon found out that having high standards was a liability. We did not have the time, the back-up or the equipment to support these high standards or even, at times, to support low standards!’

It became a matter of: ‘If you want to keep this job’, and maybe, ‘if you want to keep any job, then you better buckle under and just get on with it. Survival is the name of the game. I have a mortgage to pay and mouths to feed.’

Sometimes this can be the greatest struggle of all in working in health and other large professions. Sometimes the culture, the common practices and values of any organisation will lift you to great highs or drop you to great lows.

It is obvious to see that positive developments occur in health. Things totally unimaginable in the time of the all-powerful Henry VIII, such as stents, MRIs etc. It is also easy to see that mind-boggling incompetence occurs. You will have your own favourites. But waste, waiting lists and bureaucracy will be up there.

This all comes to mind as I read about another very important organisation of the state. The gardaí. Enough said. So how are we to ensure cultural change and appropriate quality in a team, especially a team as old and as large in number as the gardaí? Or the health service?

First, you have to acknowledge there is a problem. Yes, we all agree on this, although I have a Garda friend who can’t understand the fuss in the greater scheme of things. Making one million mistakes does not appear a great issue to him. Culture? “It is only traffic issues, after all”, he says. So all is forgiven.

In every culture, we tend to forgive ourselves for our misdemeanours, even when we are rigidly catching others out for their transgressions. Gardaí might be allowed to speed because they are seen as ‘special ones’ by themselves and there must be some privileges as part of this difficult job they do.

The gardaí are suffering huge trust issues because of recent transparency. But surely a new culture of transparency is a good thing. Should we shoot the Commissioner when the inevitable cancers become visible? Is the boss responsible for revealing the new cancers within the gardaí, or is the boss the cause of the cancer or unable to deal with the revealed cancers?

Will the boss take out the cancer and cure the patient, or will they cover up the abdomen after seeing the cancers inside? This will bring sure death. Terminal. Letting it fester and grow. Has the Commissioner got the required skills and training to cure the gardaí? What expertise and training in cultural change does she have?

Wanting to sack the Commissioner — again — seems to be an easy reflex. It is also believed that changing the soccer manager will bring change. I say that unless you can bring in a team with some proven credentials in culture change, you are at nothing. The boss can be isolated, pressured and bullied as easily as anyone.

The boss needs to be able to sack and to hire. In soccer, you can buy and sell players. In the gardaí, we have traditionally not done this. In the church, you rarely do this. In all Government posts, we rarely do this. And so cultural change becomes stunted. So the same faces and the same ideas. 

It has always interested me that I have a minor skin scar on my right hand from an accident in Australia 20 years ago. My awe of the human body comes from knowing that almost every part of my body is completely replenished in seven years. Yet the scar remains.

This is like culture. People come and go over time and yet the same scars and patterns, like fingerprints, stay the same. Changing Ministers for Health has seen very little real change over many decades. And changing the Garda Commissioner will achieve little too, unless there is a deeper understanding of what is needed to change cultural values and practices at a fundamental level.