Arriving at the MRI hospital in Manchester this (Thursday)morning reminded me why, in spite of spending billions on the National Health Service we still have major problems with hospital infections such as MRSA and C.difficile! It is a routine appointment for my daughter... we have been going for 20 years or so now and we have progressed from a run down victorian heap to a new building... unfortunately the public toilets are still in a terrible state... with the odd used sticking plaster thrown on the floor and toilet paper on the floor, not to mention no paper towels to dry your hands on.. and the dryers don't work properly! ... this is 9.00 am in the morning just as business is getting going.. just outside is the snack bar queue with surgeons wearing stethoscopes next to people off the street waitng for out-patients. The tea is good and I sat and watched a snack bar assistant cleaning the display cabinets, very thoroughly amidst all humanity pushing past her to get a sandwich! It seems to me that whilst we allow the internal and external processes to come into contact like this then the osmosis at the boundaries will ensure we do not solve the problem of hospital acquired infection. I wanderd over the rpoad to the Whitworth Art Gallery and entered a Victorian building which had just been cleaned ( I could smell the cleanliness!), went to the newly refurbished toilets and switched the taps on by non-contact actuators, used the cleanser and dried my hands under the dryer... ah now I feel clean again! There is a lesson here somewhere.
I think it has something to do with RACI. As a large organisation we were wondering how some quite important actions took so long to happen or didn't happen at all, in spite of people knowing it should happen. It reminded me of:
"There was an important job to be done, and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody's job. Everybody thought Somebody would do it, but Nobody realized that Everybody would not do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done."
We were introduced to RACI Analysis as a diagnostic tool:
Who is Responsible for making it happen? (who says "Lets do it"?)
Who is Accountable for getting it done? (who gets kicked if its not done?)
Who do we Communicate with when it has been done? (who needs to know that its been done?)
Who do we Inform that it has been done? (Who gets told its done HR? PR? peers?)
It is amazing how it can be difficult to tie down the R's and A's; and finding that C and I can be a challenge too!
The beauty of the analysis is that we can then start bringing clarity to roles for people and highlight that there are areas of initiative that people can take action without asking permission. Of course what happens is that the levels of bureaucracy become transparent. Often RACI shows that the R and A can be separated by a level or more, and the C is somewhere else. The gravity effect kicks in and we see that commands drop down but as queries, ideas, problem reporting, etc. doesn't defy gravity and go upwards. So those with R get no feedback from A and C and I get neglected... does wonders for morale!
So RACI can be used help sort out roles and responsibilities rather than jobs and tasks, so that people think "this job needs doing, I know what needs to be done and how to do it, so I will. Then I will tell these people who will be pleased to let everyone know that its been done!"
Then maybe hospitals will concentrate on important activities that contribute to good health of its "consumers" rather than make them nervous about entering the hospital!
They could start by nipping over the road to see how a Museum can be clean and ask "How do we do this?"