No shortage of bureaucrats — 5 Comments

  1. Our hospital has transitioned from the US federal government to the Tribal through a 638 process. It is the early days yet, but as a nurse for over 30 years, I have managed to cut through the red tape. Patients belong at the center of the universe, not kicked to the curb. If a person makes money in healthcare and does not see a patient, support the patients or staff members, or teach the staff that supports the hospital, they should not be in that job. Healthcare needs to involve all people in the hospital.
    As much as the English system (my Mum was born in London) Candian system (my family left Canada but my sister returned) or Australia where my cousin lives is touted by the US system as being the level to strive for, I find that those systems do not add in the cosmetic costs. The US does add those surgeries in and then we are told that we are not being frugal! The people putting the stats together lie. If the plastic procedure comes back as a regular surgery and the costs added to the bottom line. It is a game of numbers and the nurses are among the few that object to the way that healthcare is lied about!

  2. Back in 1977, Milton Friedman published an article called “Gammon’s Black Holes”. In it, he showed how bureaucracy reduced overall productivity – input up, output down. It also showed how bureaucracy feeds on itself, expanding its empire while reducing individual workload. This is known as bureaucratic displacement. Two examples from an article on the web:

    Two short stories will show what I mean by bureaucratic displacement. Some years ago I worked in a small hospital just outside London. The quality of the nursing on one particular ward was outstanding. I returned a few years later to find the ward in chaos. When I asked for the Sister who had previously run the ward so superbly I was told that she had been moved into administration. I found her in an office and she wept as she told me that she had been forced to leave her ward and become an administrator since her salary would have been reduced and fixed at a low level if she had remained in her clinical post. The focus of nursing had been changed from the ward and the patient to the office and the seminar room. The intimate care of patients had come to be regarded and rewarded as a menial task, a preliminary stage in a nursing career which was now seen to be essentially that of management as my second story shows.

    Walking along a wide corridor in a London Teaching Hospital with which I was unfamiliar I asked a person in nursing uniform the way to a certain ward. “Oh, I don’t know where the wards are, I am in administration” she replied as though I had insulted her. She turned and walked through some glazed doors which opened on to what had been a long Nightingale ward. It was now divided into a multitude of open-plan offices. Meanwhile in the A&E Department on the floor below patients were lying on trolleys for up to 48 hours and others were having their operations postponed owing to shortage of beds

    • Thanks for the comment. I, too, have experienced the shift of nursing supervisors away from direct patient care, which eventually leads to a disconnect from the needs of both the floor nurses and the patients.

      I read the Milton Friedman article you mentioned. He is speaking to the bureacracy created by the National Health Service in the UK. Here is a link to it for those who are interested: “Gammon’s ‘Black Holes'”
      Quoting from it: In a government bureaucracy that is exempt from competition, the customers have nowhere else to go. Their interests are largely irrelevant. Hence, the bureaucrat can serve his self-interest at their expense by expanding his empire and reducing his workload.
      The fault is not with the people who run the system, but with the system itself. More fundamentally, the fault is with those of us who are responsible for replacing the economic market with the political market.

      Cheers, FN

    • Read the book “God’s Hotel” by Victoria Sweet, M.D. It deals poignantly with the changes in nursing and the increase of administration.