Lessons Learned and Challenges Identified at the Hospital

The mindset is still primarily service based. It's very tough to get people thinking in terms of Whale 7, or Ambulatory in general. It reminds me of the U.S. goverment before it became the U.S. government. Under the Articles of Confederation, and during the early years under our current system, the autonomy of states, and states' rights were very hot topics. I'm no expert in this field, but I do know that it took lots of blood, sweat and tears for the Federal government to assert and maintain its sovereignty.

My main angle is to state the obvious: it's not right that a patient for one clinic should wait in the waiting room, when a room sits empty, because it's reserved for a patient who hasn't arrived, and may never arrive.

There's more room for team building work. People who know and like one another are more likely to share.

On a related but separate note: PCC's very often hear the instructions, understand the instructions, then do what they want. Yes, communication is a problem, comprehension is a challenge, but a lot of the time, it's a discipline issue.

I'm working on the balance between indirect and direct strategy and tactics. I've tended to be a direct sort of person. I've worried about doing the right thing more than how to accomplish that right thing. A lot of times, that simply isn't good enough. People are not often persuaded by large demands, or what they perceive as large demands, issued all at once. On the other hand, if you start small and build gradually, you can accomplish the same thing.

A great example of this is how much better items in an auction do when the starting price is low. People will work the price up as they get caught up in the action. Items with a high starting bid, on the other hand, are likely to be ignored.

On the other hand, sometimes you simply have to get a shovel and kill the rat in the basement.