Sunday, May 30, 2010

Things They Don't Know

The general public doesn't know a whole lot about medicine, for the most part. They don't need to, and often, they don't want to. I've lost track of the number of patients I've seen who are on medications that they do not know the reasons for. Lost track of the people I've talked to who don't understand their own medical conditions and/or who misinterpret doctors' instructions.

I am frequently amazed by the fact that most people don't know, and don't want to know, how to do CPR. Appalled by the nearby retirement community where the resident council REFUSES to allow an AED on the premises, because they are afraid of being resuscitated. What about any visitors?

And so it goes, on down to the number of times I've heard dispatch say the patient is "unresponsive," which is, apparently, the only way laypeople know how to describe someone who has any sort of altered level of consciousness.

Today, I was glad.

Got a call for an unresponsive elderly patient. On a day when I knew I'd be first on scene alone, my usual cohort being out of the country, and neither of us ever knowing if anyone else will show up at all. Such is the life of a volunteer EMT in my department. We have automatic ALS backup, which is a damned good thing, but it is not uncommon for us to go to a call and get no one else before the ambulance gets there.

All the way there, what ran through my mind was "please let this be 'bystander's unresponsive'."

It was.

I was delighted to talk with the patient. I've never been so happy to hear someone's voice.

Saturday, May 29, 2010


I used to think that all the world's problems would be solved if people would just follow one rule. I've had to revise that a bit. Two rules. If everyone followed these two rules, everything would work out just fine.

1. Don't be an asshole.
2. Don't be an idiot.

With the following corollaries:

1. Tell the truth.
2. Keep your word.
3. Take responsibility for your actions.

Add in a fair amount of "learn from your mistakes" and I think pretty much everything is covered.

Wednesday, May 26, 2010

Only a volunteer?

I have been a volunteer for a variety of different organizations over the years. Some large, some small. Some, I've been in charge of, and others, just one tiny part. Some have been run well, and others, not so well.

It is interesting to consider them all, and look at what problems they share.

Almost universal is this:
1. The majority of the work is done by a small group of people.

I think this can be perfectly fine, as long as everyone is clear that this is happening, AND there are built in positions in the organization for those who want to have small roles. The people who want to belong, but don't want to do much, should be in the small roles, and those who are there to work should be in the larger roles, and be the ones making most of the decisions.
Oddly, that seems rarely to be the case.
More often, there is much complaining and power play bullshit from the ones who don't actually want to work, while the ones who do the work, keep on working.
They have their excuses, for sure. Chief among which are "not everyone has the time" and "we're only volunteers."

Yeah. Well. If you don't have the time, don't volunteer. Or if you do volunteer, take your time (and other) limitations into account, and volunteer for things you actually can and will do. Seems that would be much more satisfying for you, as well as more functional for everyone.

And for what it's worth, being a volunteer does not mean that you aren't accountable for what you do, or that your standards should be any lower than a professional. It just means you don't get paid. It SHOULD mean that you do this for the love of doing it, or because you believe it worthwhile and important, both of which should create HIGHER standards.

Which brings me to the next nearly universal thing:
2. Those who do most of the work do it for personal reasons, not for recognition or for glory.

For one thing, there is little of either to go around. Those who just want the perks end up doing only those things that are publicly visible and/or recognized, and doing only enough to get that recognition, leaving the bulk of the real work to those who are content behind the scenes. Since that is by far most of the work, this is part of what leads to the first universal situation, of most of the work being done by a few people.

3. It can be hard to "fire" someone who is a volunteer.

This becomes an issue when you have someone in a position that requires certain things to be done that they simply don't do. Especially in a small organization, where there may not be anyone else willing or able to do that job, this can kill the organization in a hurry. Also, in a small organization, it is likely that everyone is at least acquainted, if not friends, and that makes it even more difficult to ask someone to step down, or leave, because of the emotional trauma involved, and because people generally don't want to hurt someone else's feelings. At least they don't want to do so face-to-face or in any way where they have to take responsibility for it.

Instead, they give them "time to work things out" and make excuses for why the person is not doing their job. Second chances, and third. Extensions on deadlines. Anything to avoid confrontation. Anything to avoid being "disliked." And usually, anything to keep the status quo. (Also see #6 and #7, below.)

Thing is, if the work needs to be done, it needs to be done. Someone eventually has to step up and change the situation, one way or another, or the organization will not be effective, if it survives at all.

4. An organization is only as good as its... organization.

If no one knows what is going on, or what needs to be done, or what has been done, things are not going to work very well. There must be good record keeping, and there must be good planning. Long and short term. The more open the records and planning process are, the better. Keeping people in the dark rarely leads to good.

Which leads to the next issue:

5. Any organization that does not trust its people will not be able to recruit or retain good people, and will not be able to function effectively.

The leaders of an organization must lead by example, must be worthy of trust, and must create and maintain an environment that fosters trust. This is true of all organizations, and especially true of volunteers. This includes open and accessible records and other information, and it includes not tolerating anyone who demonstrates that they can't be trusted to do what they say they will do. Building trust is a skill that not everyone has. Learn it, and earn it.

6. Politics should be left to politicians, but it isn't.

This is another thing that will lead to no good. Office politics. Cronyism. Cliques. Plain old bullshit. Any time decisions are made for reasons other than effectiveness, the results will be less than stellar. Whether it's outright favoritism keeping people in positions they are not qualified for, or simply don't do, or whether it's keeping qualified people out of a position because they aren't the buddy of the person in charge, the result is the same. Poor performance, and poor management of resources.

Where this becomes even more of a problem in volunteer organizations than in others is when there is little outside oversight. When people are not held accountable to any particular standards, they can get away with keeping their buddies happy rather than getting the job done, because no one outside the organization knows that is what is happening. Nor would they generally care.

Also, this leads to exceptions in the category of "firing" a volunteer. Instead of getting rid of people who aren't doing their jobs, often, a dysfunctional organization focuses on getting rid of people the "in group" does not like, regardless of qualifications or job performance.

Last, for today, but not least:
7. People HATE change.

Organizations that do not change, that do not grow, that do not continually work to improve themselves, will become less and less effective, until they ultimately fail.
People often seem to prefer this to actual change.
The status quo bias: an irrational preference for the way things are, rather than changing.
Been around at least as long as Shakespeare.

For those of you who know me, you might find it interesting that most of these observations come originally from organizations I worked with over ten years ago, rather than directly from any I'm involved with now. But if the shoe fits...