Alex – a Man under Pressure

When the Hospital Inspector’s Office calls, you take the call. That was the pearl of wisdom given to Alex all those years ago by his old mentor. “keep them sweet” he used to say. Those were wise words as these officials can wield much power with their reports and “final scores.” Your position in their “quality” league tables matters, despite all the protestations that it doesn’t, and Alex, ever mindful of this, dropped everything to respond to the Inspector’s call. “They’re coming next week,” he yelled through the door to his secretary, “get the inspection machinery rolling.”

As if it had received a call to arms, the administrative infrastructure of St. Angela’s University Teaching Hospital got into gear, fast. All the necessary papers, reports and examples of “best” practice – “good” is not enough – were mustered in the hospital’s very grand boardroom. Alex knew he had to put on a professional show as there were rumours that his hospital would be subject to a merger. Well, that’s what they called a hostile takeover in those days so that it would look like everyone was working in “partnership.” Like all Chief Executives caught up in this situation, he was very anxious.

“Oh no, disaster” he cried on hearing that the Inspector’s Office had indicated that Reggies, the children’s hospital on St. Angela’s campus, was to be included. “That place is stuffed with problems – all those prima donnas,” he said in despair.

“Too late, they’re coming” said Sue, his ever-present and trusted fixer, officially entitled the Director of Organisational Development and Human Resources. Including the children’s service in the inspection added complications as it was much harder to control the environment – the children, the parents, the toys, the noise, and, worst of all, some of the medics. And as for rules, they didn’t understand them and therefore they didn’t obey them – it was “adult stuff.”

Alex was concerned about the regular “nappy scandal” drum beat from the local press. It stuck to him like the glue paste that was smeared over everything he touched at Reggies. The editors wouldn’t let it go, no matter how many times Alex had explained that the computer glitch was now fixed. Clearly, a rookie reporter had got the brief to pursue the story and keep it in the public eye. It was the talk of the local supermarket checkouts, bus queues and waiting rooms – it had legs, as the editors used to say.

The rookie reporter generated interest from the big boys at the national press. They started phoning him for new pieces – a glimmer of recognition which was sufficient to keep him on Reggies “nappy scandal” case. With the pressures feeling like a vice around his head, Alex tried to run his hospital, and get it ready for the forthcoming inspection. Then the phone rang. It was the police. They had arrested one of the Reggies doctors.

The Car Boot Sale

“It’s our old friend Rudey Rudi,” Sue explained as she updated Alex on the arrest. Dr. Van der Loo, our prima donna pathologist with the souped-up yellow sports car, had spotted a wheeze to make money to pay for the children’s Christmas party. Having skidded on a fallen ice cream as he drove up and along Reggie’s loading bay, and then crashed into the wall of excess stock of nappies – the result of a gross over‑order – Rudi picked up the broken boxes and took them away, as you do. Now when things are computerised, you have to tell it when some stock has been removed so it knows it must generate a reorder. Rudi ignored that bit, with dire consequences for Reggies, Alex and the inspection.

The broken boxes appeared in the public car park at the weekend car boot sale. Queues quickly formed as mums got the word that boxes of nappies were going cheap. Of course, the boxes were damaged, but the contents were not, and the funds generated were for sick children. It was meant to be. It was a happy bustling morning and all were satisfied as the goods changed hands.

The rookie reporter got wind of the sale and phoned the local police so he could get a picture of them as they turned up to make inquiries. The police, always on the look out for dodgy goods being shifted at car sales, duly obliged.

So, camera at the ready, our rookie snapped Rudi handing over hospital goods in exchange for cash from eager mums from his car boot as the police arrived. “What’s all this?” inquired the law officer.  “It’s a sale of nappies” said Rudi in a matter of fact way -just before he was arrested for passing off stolen goods.

Alex was too busy, and depressed, to give a statement to the press so he asked for one of Reggies senior doctors to respond. Big mistake. Up popped Dr. St. Clair, our prima donna who had organised the fabulously expensive bunting at the recent fête, and a great supporter of Dr. Van Der Loo. In front of the press, and all those clicking and flashing cameras, Dr. St. Clair declared his support for his colleague Rudi and boomed that he couldn’t see what all the fuss was about. After all, it was only nappies in broken boxes and the sale was for a good cause.

Meanwhile Sue, on behalf of the hospital and Alex, stood bail for Rudi as he protested his innocence. “What did you think you were doing?” she asked as she drove him to Reggies. Rudi was more concerned about his car which was in the police pound, confiscated as evidence in a crime. Without thinking, he let out that some of the Reggies porters and drivers had relayed more boxes to him in the car park as supplies ran out; they thought it was for a good cause and an official sale. Oh dear …

The Inspector Calls

With all the fuss, Alex wasn’t at his best when the inspector and his team arrived. They proceeded to the boardroom, ordered coffee, and sat down to plough their way through the piles of paper that had been laid out for their perusal. The inspection team worked in silence and wrote notes from time to time on their bright yellow notepads. Alex awaited the call from the chief inspector in his office. He prayed that they would focus on St. Angela’s and run out of time for a visit to Reggies.

It was not to be. Their site visit around St. Angela’s was very efficient as the team split up and covered the necessary ground in half the time allocated. They assembled in Alex’s office for a discussion about their findings over the sandwich lunch provided. Nothing too fancy – it wasn’t the executive level platters. He did not want to give the impression of profligacy. Just as they were finishing their coffee, Alex saw a bundle of newspaper clippings emerge from the chief inspector’s folder. He could see they were all about the shenanigans at Reggies. He was worried. He didn’t need a poor inspection report with a possible merger buzzing in the wind.

Fortunately, Sue and the admin team had worked hard all morning to make sure Reggies frontage and reception hall were gleaming and all the toys had been tidied away.

Things were going well until the chief inspector, with his team in tow, asked to visit one of the wards. Leading the way, Alex took them upstairs and introduced them to Willow ward’s head nurse who showed the party around. Word got around fast that the inspectors were “on the floor.” But the tour of Willow went well and concluded with the usual smiles and handshakes.

As they left, the chief inspector spotted another ward at the end of the corridor so he led his all-smiling and almost relaxed party, and Alex, to Maple ward. Inspectors are allowed to make unannounced visits. Dr. Anderson, another one of our prima donnas, spotted them as they entered his ward. Fuming about poor Rudi’s arrest, Dr. Anderson exploded in rage that these people had entered his ward without permission.

Putting his hand out, flat palm showing, he shouted at them “No; you are not coming on to my ward. You haven’t asked for my permission.”

Alex was dumb struck, as was the inspector and his team. Sue tried to calm the heated atmosphere as everyone stopped in their tracks. The chief inspector led his party away in high dudgeon. 

Hot Off the Press

Our rookie reporter couldn’t believe his luck. Alex couldn’t believe his. The press reports were grim. The “nappy scandal” was on a roll with Rudi’s arrest and bail, and the inspectors’ marching orders were the talk of the town. Alex awaited the report with trepidation.

Willow and Maple wards went about their usual business as if nothing had happened. Dr. Anderson was rather pleased with himself for asserting his clinical authority over “administrators.” Dr. St. Clair puffed away on his pipe at the back by the oxygen cylinder store, ignoring the explosion risk warning signs as usual. And as for Rudi? He appeared in court and got off with a caution as Reggies stepped in to defend his stunt as a hospital fundraiser for the children’s benefit.

When he saw the inspectors’ report, Alex knew he was in trouble. “Clinical leadership is woeful” it groaned. “Reggies needs a team-building programme” it suggested. “Management needs to get a grip and introduce objective-setting for doctors” it said earnestly. It looked as if Alex was being set up as the sacrificial victim.

Alex sunk into his big comfy executive chair and stared out of his dual aspect window in his sumptuous top floor corner office. He had tried, but what could he do with a basketful of problem prima donnas? Reggies was totally dependent on these experts, and they knew it. Alex had tried all the latest management gimmicks to no avail. The inspectors had not understood, in his view, the problem of managing experts, perhaps because they didn’t have to. Keeping them in line was easier said than done.

As he watched the early morning rowers practising their strokes on the river, he reflected on the prospect of having to leave this place. He loved this hospital despite the psychopaths and difficult people he had had to deal with over the years. He had put his all into it but life was very unfair. Why should he be pitched out because of a rotten report, he asked himself. Better to go down fighting. And so our weary Chief Executive mustered himself once more to rebut the inspectors’ report, and to fight the coming merger.

The Trail of Misery continues

Having picked himself up again, Alex opened his office door to find the head of supplies waiting to see him. Reggies had run out of nappies again. “What?; How?; I thought we had stacks of the things lining every corridor,” Alex pleaded in despair. “We did” came the reply. That heart-sink moment had arrived again as Alex listened to the explanation.

Rudi’s recent stunt had removed stock in an unauthorised way so while the computer thought Reggies had loads of nappies, it had actually run out of them. The “reorder” trigger had not been activated. “You see,” said the man from supplies, “computers are stupid.” So Alex had to authorise the release of cash once again for the nurses to go over to the local supermarket to get emergency supplies. And of course the rookie reporter was there with his photographer to record the humiliating “trail of misery” once again.

Our journey through the “Kingdom of Sweets” at Reggies is at an end. We have seen the difficulty that prima donnas present – irresponsibility, resistance to management techniques, and, from time to time, their behaviours can be mimicked by others. You wouldn’t put up with it if you didn’t have to. Alex and his team understood these truths, and let things go when necessary. He was a wise man.

There were merger straws in the wind for St. Angela’s and Reggies. Despite the rhetoric about partnerships, it was going to be a hostile takeover in the name of efficiency gains, or service improvement, or something like that. Alex and his team were about to meet some old foes on the other side, one being his nemesis in former times. The important question for Alex was how the medics would line up. Would they back him, or run to the other side?

The merger story is a sorry tale of power struggles, conflict and gang warfare, and court cases. It’s complicated so it’s going to take a book to do the battles justice.

Come back in the spring next year when the book will be ready. In the meantime, catch up on reading the monthly pieces that form the three chapters on organisational psychopaths and their work in the vein of Macbeth, Lear, and Romeo and Juliet; and the chapter on prima donnas in the vein of the Nutcracker’s Kingdom of Sweets. Enjoy the read and I’ll keep you posted each month on The Book … … …