The garbage people: unintended consequences of change

With a capacity for 20 000 people, the cave church of St. Simon are said to be the largest Christian church in the Middle East.  The church’s limestone walls have breath-taking carvings.  Getting there requires travelling through a section of Cairo’s Manshiyat Naser neighborhood known as the garbage city. This is breath-taking in a completely different way…

Your senses alert you that this is the garbage city, the putrid smell is intense and there is garbage everywhere.  Garbage fills the narrow streets, the balconies, kids play in it and the shops are hidden between garbage. Garbage city is home to the Zabaleen (garbage people).  The Zabaleen travels from house-to-house in Cairo, collecting household waste and transporting the collected waste back to the garbage city. Each family specialize in a type of garbage that they sort, recycle and sell.

Until 2003 the Zabaleen collected garbage at almost no cost to the government and residents of Cairo.  Their main income came from recycling the garbage.  It’s estimated that in 2003 the Zabaleen recycled 80% of the garbage collected.  This was described as one of the most efficient recycling systems globally and it has earned the Zabaleen international acknowledgement.



View from the car window


The Zabaleen are Christians in a Muslim majority country.  In the recycling business this provides them with a competitive advantage: the ability to keep pigs.  The Muslim’s religion does not permit living close to or keeping pigs. Most of the waste collected is food waste; the Zabaleen recycles this by feeding it to their pigs to fattening them up.  Once fat, the pigs are sold, providing further income.

The improvement: fake green grass on the other side of the fence

In 2003, the Mubarak government decided to ‘modernize’ the garbage collection system of Cairo by adopting the systems used in Europe.

Unintended consequences of the change

  • Adverse impact on the socio-economic stability of the Zabaleen
  • The modern mechanism of compressing garbage complicated recycling and the level of recycling dropped
  • Cairo’s streets were too narrow for the mechanized equipment, uncollected garbage was dumped by the residents
  • The new collection system introduced higher fees resulting in further illegal dumping, burning of waste and increased pollution

To compare: in 1997 the Zabaleen collected 3000- 4000 tons of garbage per day at almost no cost to the government; they recycled about 80% of the waste collected.  In 2004 the government was paying ten times more to have only 60% of the garbage collected and 20% of the collected garbage was recycled.


Then in 2009, the Egyptian government ordered the slaughter of some 300 000 pigs as precautionary measure to prevent swine flu (H1N1). This effectively destroyed another vital aspect of the Zabaleen’s recycling methods.  The WHO called the killing ‘scientifically unjustified’. The government’s actions against the Zabaleen was almost certainly politically motivated and grounded in religious tensions.

Moral of the story

There is a tendency to view another country, organization or functional work unit’s methods as superior.  It is problematic when these methods are adopted without considering feasibility, cultural differences and why the current system operates the way it does. There is always a reason for the faults in the current system, a few examples would include hierarchies, history or power struggles.



The grass is not always greener on the other side….


Even in healthcare, when low-middle income countries (LMIC) undertake to improve their healthcare systems, they often model their interventions after high income countries (HIC).  However, HIC have the enabling infrastructure to support advanced health systems. In LMIC’s with poor roads, it would be more sustainable to invest in bicycle ambulances than to establish ambulance services.  Rather than develop university curriculums, train community first responders in the rural areas.  Instead of creating an urban center of excellence, provide electricity and running tap water in all the small rural clinics.

To the Egyptians, investing in the Zabaleen’s existing informal system would’ve probably been more beneficial, cost effective and sustainable.  By disregarding the functioning informal system, the policy makers destroyed a functioning system and adopted a system not suitable for their setting.  This resulted in failure so devastating that it’s even been cited as a reason for the 2011 uprising.

There are a few lessons that we can take from this:

  • Don’t discard local ownership
  • Thoroughly observe and analyze the current situation prior to suggesting change
  • The above implies spending time to explore the current situation
  • The first consideration should always be to augment the local/informal system or to formalize the informal system
  • If the solution is adopted, make it context specific, in other words innovate on what worked somewhere else
  • When formal systems are developed it should be done considering the integration of formal and informal systems from the beginning

Disregarding the above will result in change programs that are not sustainable.  Not integrating formal and informal systems result in parallel systems where the systems compete to the detriment of both.


A year after implementing the ‘modern’ system the Egyptian policy makers had to acknowledge failure. A decade later they are taking steps to integrate the Zabaleen into the formal system.  They are also investing in the Zabaleen that now have uniforms and vehicles.

In short, don’t solve problems that don’t require solving, observe, investigate and find the real and right problems.  Solutions should be feasible, involve the locals and the informal systems and don’t ever blindly adopt, rather innovate and make change context-specific.

To watch a short documentary about the garbage people

Read more

Wael Salah Fahmi. Keith Sutton.  (2006)  Cairo’s Zabaleen garbage recyclers: multi-nationals take over and state relocation plans.  Habitat International 30 (2006) 809-837


On ‘death and dying’ and organisational change

‘Buy-in’ is a term commonly used when talking about change in the workplace. We want everyone to buy in to the change.  Often, supervisors and managers appear completely perplexed when people do not simply buy in or change their ways when told to.  Numerous books have spoken about ‘managing change’ and ‘obtaining (the elusive) buy-in’.

The lean methodology addresses some crucial aspects of ‘obtaining buy-in’,  including involving the people performing the task in the change process, empowering people to experiment with new ways, and coaching employees in problem-solving techniques.

There is a significant human factor that, if ignored, hampers sustainability of change: emotions.  In the work environment, where change is underway, these are labelled different names such as resistance, anger, or passive aggressiveness.  In this blog we will call this emotion grief.

We become emotionally attached to our routines, and our way of doing things.  And even though we might logically know that it’s not the best way to perform a task, we experience a feeling of safety and a sense of belonging within our routines.

In organisations with strict hierarchies and bureaucracies with red tape such as hospitals, those that have been around for a long time find and establish the loop holes which enable workers to get the job done based on longstanding networks and local knowledge.  Long-serving staff may view a suggested change to the way they do a well-established process as a threat. Exposing the loop holes can lead to feelings of vulnerability, frustration and anxiety about getting into trouble with management; especially within the ‘blame culture’ typically found in these bureaucracies.

Elizabeth Kubler-Ross, a psychiatrist who studied near-death situations and the emotions involved,   identified five stages of grief as a pattern of adjustment: denial, anger, bargaining, depression, and acceptance.  Each person will pass through these stages at their own rate and in their own way.  The task of a grief counsellor is to provide support during these phases.

A criticism of the model is that Kubler-Ross did not adequately take into consideration the role that the personal environment plays.  Certain environments make grieving easier.  And not everyone experiences grief in the same way, as some people are more resilient and adapt with little grieving.   Charles Corr, a social psychologist and a critic of Kubler-Ross’s work stated that grief and resilience are influenced by patient empowerment.  The more empowered the patient, the faster and better they adapt to the end of life situation. He highlighted two important aspects from Kubler-Ross’ work that I think are also true for organisational change: 1. that each person will react in their own way to the challenges that confront them, and 2. that one cannot become an effective supporter or carer unless one has learnt to actively listen to the person grieving.

How do we create an environment where employees feel empowered during the ‘death of the old ways’?  This question is particularly difficult to answer in the beginning of a lean journey, where management (and the organisation) are using traditional methods, the ‘blame culture’ is still firmly established and people have no success stories to demonstrate that the changes are in fact improvements.

I’d like to suggest though that we can better support employees during organisational transitions by preparing people for change, supporting their emotions during change and making it ok to grieve.

Grief is personal and subjective.  We can’t measure grief by comparing it to other people’s grief or phase of adjustment. We need to create an environment in which it’s safe to express emotions without judgement, where concerns are not simply dismissed, challenges ignored and what-if scenarios discarded. Emotions and feelings should not be denied when implementing change, otherwise staff will feel oppressed and devalued.

As such, I am making a case that the direct line manager is not the most appropriate person to provide emotional support during large-scale change initiatives.  The line manager is emotionally invested in the change and going through their own grief and adjustment, especially if they are confronted with challenging their beliefs on how to manage and problem-solve within their unit. They are grieving themselves.

So who should provide support then?  Could Human Resources become more involved? Is this perhaps a role for HR departments, with an understanding in lean thinking?  I’m not sure.  What I am sure of, though, is that whoever provides emotional support needs to be like a grief counsellor:  slightly removed from the actual incidence, with little emotional investment in the operational processes and ways.

Kubler-Ross: Phases of grief in organisations

Denial:  This is often expressed through statements such as, ‘We don’t have any problems in our department.’  or, ‘If only Department XYZ worked harder, faster or better, then our results would improve.’

Anger: In organisations this is expressed as passive-aggressive behaviour rather than actual aggressive outbursts.  If the not-so-obvious symptoms of this phase are not managed, the change will not be sustainable.  It’s important to support people through all the phases; however the anger phase is probably the hardest to diagnose as its symptoms may be subtle. Behaviour or symptoms of the phase include obstruction, lateral violence and bullying of others.  Other symptoms may include threatening to resign or requesting a move to another department.

Bargaining: If anger is the hardest phase to diagnose and support, then bargaining is the tipping point for change. The following remarks may be heard in this phase: ‘This is additional work, so I will make the change if you increase my salary’, ‘This is not in my job description so we need more time/resources/payment and then we will be able to follow through with this’ or ‘If this way doesn’t work, then I will leave and go work somewhere else’.  These employee responses should be carefully managed if the organisation would like to move past a point of consistent bargaining or negotiation towards sustainable change and behavioural acceptance.

Depression:  People might appear to be sulking, sullen and unhappy at work.  An important ‘sub-stage’ of depression is testing: testing the new ways and acknowledging that the new ways are not  all bad, but the employee is still not ready to openly accept it.  This is when people come to the realisation that perhaps it is not as bad as they thought.

Acceptance:  This is the‘buy-in’ you were hoping for from the start, or acceptance of the change.


Lean organisations should strive towards resilience, a state that is at the other end of the spectrum to grief, because people feel safe, supported and are able to adapt within their environment.  This desired state of resilience takes time to attain.

The phases of grieving must be diagnosed, addressed and managed.  If this is not done appropriately it will have long-term adverse effects, including bullying or consistent bargaining to perform tasks.

Until organisations reach the point of resilience, they need to plan emotional support into the improvement process.  This emotional support should not be seen as an extension of the direct line manager’s task.  Rather it should be outside of the functional unit. This is of the utmost importance in organisations starting a large-scale lean transformation.


The stages

Communication: Semmelweis vs Florence Nightingale

A comparison of two intriguing nineteenth century change agents.

The lady with the lamp: Florence Nightingale, founder of modern nursing, demonstrated the effectiveness of hospital design and administration.

The saviour of mothers: Ignaz Semmelweis, demonstrated statistically that puerperal fever could be reduced by hand washing and implemented hand hygiene at the point of care.

The one was acclaimed during her lifetime; the other died an outcast of medical society in a mental institution at the age of 47.


Semmelweis (DOB 1818) and Nightingale (DOB 1820) lived in the same era of health care development.

Both had novel ideas that challenged the existing status quo.

Both used statistics to demonstrate their findings (not commonly used at the time).

They made their world-changing discoveries roughly at the same time (1847 and 1854)

Their discoveries were in the same branch of medicine: spread of disease.

Neither one was completely right.  Semmelweis failed to realize that puerperal fever is an airborne and contact disease.  Nightingale lacked “scientific” insight into the spread of disease.

Brief backgrounds

Nightingale was a lady from the upper class in the Victorian era of British history; women had no legal rights and a Victorian lady’s world was strictly confined to home and family.  Florence’s father held progressive views on the education of women and she was well-educated.  However it remained a radical concept that a privileged lady would want to have a career, especially as a nurse!  Nursing was considered a job for untrained, uneducated women with no other prospects and of poor social standing.

Semmelweis was born in Hungary, the 5th child out of ten in an affluent family from German ascent. He was a physician and worked in a large training hospital in Vienna.  There must’ve been a degree of underlying tension for the Hungarian physician working in Austria due to the European political framework of the time.

How did they communicate their findings?

Florence Nightingale consistently communicated and consulted widely, publishing approximately 200 books and 12 000 letters.   Nightingale was strategic in her allegiances.  She attracted talented and powerful collaborators, connecting with a variety of influential people.  She networked across boundaries, even internationally.  Her collaborative efforts with Sidney Herbert are well-known and demonstrate her ability to influence the right people.  Sidney Herbert carried weight in social circles, he had an influential position and enough access to the Queen to make promise Florence prior to Crimea “unlimited power of drawing on the government for whatever you think requisite for the success of your mission.”

Semmelweis was a reluctant communicator and words used to describe his style includes dogmatic, arrogant and ego-driven.  He displayed a tendency to describe his peers using words such as irresponsible murderers, criminals, adversaries and partners in the massacre.

With the implementation of Semmelweis’s hand washing at point of care idea the mortality rate dropped from 18 – 1%.  For reasons unknown he refused to communicate his reasoning and findings to the learned circles. Only fourteen years after the experiments and after he has left Vienna did he publish a book.  The book was poorly received as it was reportedly poorly written and hard to follow.  Semmelweis responded to the reviews by writing public letters, which did little to win support within the scientific community. He died four years after the publication in a mental institution.  His admission to a mental institution is filled with myth.  He’s reasoning was only accepted 20 years after his death with the further discoveries on the germ theory of disease (Louis Pasteur) and antiseptic techniques (Joseph Lister).

Could Semmelweis have had a greater impact if he could communicate differently? I think yes…

The power to influence

Obtain buy in.  Most of us view ourselves as individuals making independent decisions based on facts, however the behaviour of similar others (our peers) have an influence on our decisions, not to mention our preconceived notions.  When the way that we interpret facts are questioned it threatens our truth and the way we see the world resulting in self-defensive behaviour. The gentlemen doctors in the nineteenth century did not believe that their hands carried germs.  For fourteen years Semmelweis declined to share why he was so forcefully challenging this status quo and insulting his peers.  Semmelweis behaviour made it easier for his peers to shun him than to challenge their own beliefs and buy into his message.

Don’t force your opinion (even if it’s right). Semmelweis felt passionately about his message and his statistics proved that he was “right”.  So he forced his message and when it didn’t work, instead of reviewing and adjusting, he raised the tone, making it more aggressive.  He kept pushing, refusing to consider other’s inputs and views.  It’s not only about the facts; it’s also how we go about communicating and adapting our message that counts.

Use a consistent message in different ways. Nightingale used various ways to communicate the same message.  She wrote letters, books, presented statistics, comparing English and French outcomes and collaborated widely.  She wrote in simple English and innovated difficult statistics into easier visuals ensuring that her message was clearly articulated and understood.

Apply some charm. In addition to our bias, we are more likely to follow the lead of people that we like.  This makes charisma an important leadership and change agent trait. Charismatic people are skilled communicators communicating using just the right amount of emotional appeal to lend credibility to their message.

Nightingale’s background prepared her to be an intuitive and skilful communicator.  She innovated to clarify her message (statistically); she used her influential collaborators and she was persistently persuasive. The power to influence people and get them to work with you or even on your behalf is and advanced form of social interaction. I think Nightingale was a clever strategist and communicated with intent.


There is a Chinese proverb that states that he who threads softly goes far.

Communicating is a skill. When challenging the status quo we need to be intentional, adapting our personal style yet remaining true to ourselves and our truth.

Footnote:  Semmelweiss was able to make his deductions after comparing a nurse driven clinic (low mortality rates) and a doctor driven clinic (high mortality rates), Nightingale made her deductions from nursing experience.  Both cases illustrate the important role of nurses in improving and advancing health care.

The unsafe workspace…patient rage caused by waiting

Waiting feels like a waste of time and is intensely disliked by most people. I used to avoid the waiting area of the emergency centre like the plague, especially on busy days.  At times it would feel like the patients in the waiting room has become an angry mob and I was uncomfortable just walking past. It’s like there is a “peer pressure” in waiting rooms and if one patient complains shouts or is rude it gives permission to others to join in.

As manager I had to deal with patient complaints and staff emotions after a busy day, staff was left feeling emotionally depleted after some shifts.  Last week I attended staff meetings in different parts of an outpatient clinic.  Their previously day was exceptionally busy and the staff expressed similar emotions. There was an increased burden to process more patients, files, scripts and exposure to what I would like to call “patient rage caused by waiting”.

Why the rage?

Hospitals are emotionally taxing environments. Visiting a hospital is stressful for patients and their family. Whilst waiting in line the patients may be in pain, they might’ve just received bad news about their condition; they might lack clarity about their condition or need to come back for more tests or results.  They are required to join a variety of queues for different functions:  registration, doctor consultation, tests, scripts, to make a follow-up appointment and so on.

Add in the length of some queues, poor communication on why they are waiting and duplicated work. Now add in the environment that is crowded, with poor ventilation, unsettling amounts of noise and limited signage of where to go next.

Truth is that patients spend a disproportionate amount of time waiting for that little value adding step and reason why they came to the facility, and then…it’s over in minutes. They might wait three hours for a repeat script. They might wait four hours to be attended to for ten minutes by an absent-minded doctor.

There is so much uncertainty of not knowing what is happening and when it’s happening that it is no wonder that the patients become agitated.

How patients demonstrate their agitation

Both verbal and non-verbal ways of demonstrating unhappiness are traumatic to the staff involved. Verbal rage includes speaking in a raised voice or making verbal threats and insults.  Non-verbal rage may include glaring, rolled eyes or shaking the head.  Emotions can evolve and escalate so basically if the patient’s agitation is not addressed constructively the more queues the patient joins in this emotional state, the more likely emotionally fallout are.

In a study done with Emergency Centre nurses in the USA 97% of nurses reported to have been victims of verbal abuse in the year preceding the study.

A study done in Japan took it one step further. Staff that reported verbal abuse was asked to complete a questionnaire designed to diagnose Post –traumatic stress disorder. The result: 21.3% scored positive for PTSD.

The patient is always right…Not

The buzz words the past few years have been patient centred care, quality care and the patient journey. Regrettably quality patient care and service delivery is associated with the idea that the patient is always right. This idea has resulted in excessive tolerance to be displayed towards patients that are misbehaving fuelling unrealistic expectations by the patients and perhaps creating a certain sense of entitlement.

There’s been this message that the patient’s emotional outbursts and verbal abuse of staff is the result of bad service practise. In one of the hospitals that I worked at we were consistently told that patient outbursts were due to us being lazy, that’s it root cause: lazy staff.

It creates pressure that you will end up in trouble for the patient’s behaviour. Frontline staff feels responsible for patient aggression and if only we did this or that; the patients would not have shouted at us. It is overwhelming and when you compare the emotions and if only’s with the three stage cycle of domestic violence, the similarities are scary.

Patient expectation is often unrealistic and a large part of frontline staff’s jobs revolves around managing expectations and fire fighting. It’s time to acknowledge that it may be unrealistic or hard to deal with.  It also needs to be acknowledged that patients do step out of line.

Where is management?

Bishop et al (2005) did a study on violence in employment services. They demonstrated that although service providers experienced customer behaviour as violent, it was systematically denied by management who failed to acknowledge the behaviour as violent.

Hospital management owe it to the staff to provide a healthy and safe work environment. And perhaps on a busy day hospital management should support frontline staff by visiting patient waiting areas to speak with patients and check in on staff.

Yes to make it better for the patient. Yes the patient is important.  Yes we should be patient centred.

However we need staff to care for patients, to feel compassionate and to pitch at work.   The impact of a verbally abusive patient may linger long after the patient has left.  Exposure to aggressive behaviour by patients has long-term psychological effects on staff including staff burnout, diminished job satisfaction, reduced self-esteem and morale.

This can increase absenteeism which creates a vicious cycle of more pressure on the remaining staff, high turnover of staff and a negative work space.


I’m not sure if there is any fixes to ultimately resolve waiting times and queues.

What I do know is that we need to think about the impact that our dysfunctional system has on staff retention and satisfaction.

I wish that I could find the right words to express that emotion felt by health workers, the sense of futility, regardless of how hard I work and try, they shout at me and then it’s my fault.

For too long in health care we have said that it’s ok if patients direct their rage at us. That it’s part of the job and that it’s something that staff on the floor just need to accept.  You are seen as street savvy if you can cope with it. We need to change this thought process, now!

Bishop, V., Korczynski, M., Cohen L. The invisibility of violence: Constructing violence out of the job centre workplace in the UK. Work, Employment and Society, 19 (2005), pp. 583–602

Relentless leadership

Lead like a relentless but reflective bulldozer.   I’m off course referring to the LEAN Institute Africa’s 2014 summit theme.  I’ve summarized some of the summit’s consistent themes regarding the traits of such a leader.

The LEAN Africa’s Institute’s pamphlet for the 2014 summit defines the relentless leader as a purposeful leader, continually driving for improvement whilst simultaneously being compassionate. Thesaurus defines the word relentless as sustained, unremitting and unyieldingly severe.

Traits and ways of the relentless leader:

  • The relentless leader acknowledges participation.  The relentless LEAN leader realizes that people are more involved when they feel appreciated and acknowledged; therefor they find time and ways to encourage participation and experimentation.  The relentless leader not only knows that it’s about the people but also cares deeply about the people.
  • A relentless leader sets direction.  They do not simply introduce a toolbox.   They start by creating a shared vision and philosophy. The most applicable tools are adapted to suit organizational need and support the shared vision.
  • A relentless leader is persistent. There is no end to improvement.  The relentless leader makes LEAN stick; the relentless leader takes the organization beyond LEAN being a project, fad or process with an end date.
  • Relentless leaders are information conduits working consistently towards creating a corporate memory.  Relentless leader creates a focus on producing knowledge in the same way that one produces work.  Every problem is an opportunity to learn and generate knowledge.   The relentless leader ensures that there is no space for exclusivity and knowledge is shared across functional boundaries.  They know that functions may be specialised or specific to a work area; however the significance of knowledge is collective.
  • The relentless leader is a good listener and finds the problem before offering solutions.  In emergency medicine we teach that the most dramatic injury is not necessarily the most serious injury.  For example if a person has an obviously broken bone that you see as you approach and you immediately focus attention on that, you may miss that the person is not breathing and has no pulse.  So they will have pretty splint but also be pretty dead, because you didn’t address the real problem.  So don’t get side-tracked by the noise and always follow the same systematic approach. It’s the same with solving problems what appears to be an immediate problem and/or solution is most likely not addressing the root cause of the problem.
  • The relentless leader is visible at the workspace and makes gemba tangible.  Gemba is not simply going to the workspace to “see” the problem.  Gemba is going to the workplace and observing until your mind shuts up, applying all the senses.  It’s like meditation, you need to feel the workspace and observe the work cycle.
  • The relentless LEAN leader leads by example:  their office is neat, they use visual management tools, they can find data easily and they share knowledge.  They know that you can’t “delegate” LEAN or not have time for “LEAN” expecting that the team will then make the time, and buy into LEAN if it’s not visible from leadership.
  • The relentless leader is consistent. LEAN is not just for when things are going poorly.  It is habits that are formed by practising it every day.  These habits includes measuring performance, huddles, daily activities, workplace discipline, the relentless leader is consistently setting the pace and leading by example.
  • The relentless leader respects and values the team.  As such the relentless leader considers that when bringing about change for the first time, it’s scary and unknown.  They know that there will be resistance.  To add a little bit of my own spice, with regards to change I’ve been taught to apply the grief process as extensively described by Elizabeth Kuber-Ross to understand the initial resistance.  The relentless LEAN leader intuitively plans and allows for some adjustment and that there may initially be denial, maybe even anger because the workplace is changing.
  • The relentless leader measures performance.  The analogy presented was if you are a rugby fan and its 20 minutes into the second half when you first tune in on the tv.  What is the first thing that you look at?  The score.  Because that gives you an instant update of how the game is going.  The relentless leader knows that in order to know the score, the right score must be kept and displayed to the team.

I think that it’s the mission of the relentless leader that sets them apart. And I would like to add a quote by management guru Peter Drucker:  “The three most charismatic leaders in this (last) century inflicted more suffering on the human race than almost any trio in the history: Hitler, Staling and Mao.  What matters most are not the leader’s charisma, what matters is the leader’s mission. “

Generating knowledge in health care

Hospitals are organized around lots of functions. In such a complex system with numerous functions and actions all happening at the same time our biggest challenges is the lack of reliable mechanisms and knowledge to integrate all these functions into a coherent whole.
We tend to become our position and function and we may be blinded to how our function is affecting someone else’s function. We are so busy fighting our own battle that we are not seeing the big picture unless we learn to look for it.
This is aggravated by health care services traditionally being a culture of existing individual experts (silo’s) where knowledge is not typically shared across the boundaries. (Think surgeon’s vs anesthetists vs physicians). And hierarchies
Often when we are confronted with limitations within the functions of our field of expertise, we have an assumption that fixing or providing the ideas is the function of another department, our supervisor, hospital management etc. Not us, we don’t give ideas. We sometimes forget that we all serve each other – department for department and function for function. Think about a problem that your department has simply been “working around” because you have only been working towards meeting the patient’s immediate needs within your department.
Health care needs to start sharing knowledge, insights and stories to create overlaps. These overlaps creates the ability to gain knowledge, to be informed of what other departments within our organization are doing (hospital/ ambulance service) and to share our stories to drive innovation.
In my experience there is an abundance of good ideas in our health care organizations, sadly though they are often dismissed as soon as they are shared with all the reasons why it won’t work. We need to change our stories and our language to overcome these barriers so that we can become nurturing towards good ideas.