Perpetuating the Problem

A previous post considered the strain experienced by first line managers when sorting out conflicting priorities. A reader, Peggy, noted that juggling multiple—at times incompatible—priorities challenges nurses everywhere.

Before exploring solutions, it is a good idea to pause to consider: Why does the problem persist?

The problem is widely recognized. Health care leaders know that conflicting priorities cause considerable strain for their FLMs and providers. Identifying the problem does not prompt immediate action to correct the situation.

Conflicting priorities is a meaty problem. It goes directly to the core mission of the organizations, their workgroups, and the individuals who do their work. Addressing this problem requires addressing some key issues in the management and leadership of health care organizations. No one undertakes that sort of job lightly. Many avoid the issue entirely.

At the root of the problem lies mission overload. Stakeholders’ expectations exceed the available resources. Whenever there are multiple stakeholders, overload arises. Each stakeholder can argue that there are sufficient resources to cover its objectives. Each has a limited awareness of and even more limited commitment to the additional objectives of other stakeholders. From the each stakeholder’s perspective, the overload problem can be resolved by simply focusing on the primary mission. For individuals or groups within the organization, the list of items encompassing everyone’s idea of the primary mission is vast.

Senior managers face a dilemma in power allocation. Centralizing power by making a hospital-wide declaration of priorities is going to create resistance. Some stakeholders’ cherished objectives will be lowered in priority. Even people in senior positions dislike having their decisions criticized.

Further, hospitals are such complex, multi-functional organizations that across-the-board priorities will fit unevenly. A set of priorities for an acute treatment unit differ markedly from those of a support unit, such as a diagnostic laboratory. Allocating authority down the line makes sense; it also alleviates strain for senior management.

The strain then is passed along to lower-level managers, eventually coming to rest on first line managers (FLMs) and to nurses. They lack the authority to proclaim the unit’s priorities unilaterally. So, they make the best of the situation by making ad-hoc judgments about how the unit or the individual should allocate her resources.

Regardless of how that allocation occurs, individuals are open to criticism. Although their decisions will find some support, those decisions will also be criticized.

How do they cope in the short run:

1. Procrastinate: Putting of decisions as along as possible delays the inevitable. This strategy will encounter resistance but that may be preferable to challenging a stakeholder’s priorities.

2. Keep their heads down: They prioritize activities without actually acknowledging that is what they are doing.

These are poor strategies. We really need to do better.

More to come.

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