The hospital

I work as a quality improvement officer at the Riverside General Hospital (RGH). It's a big hospital; not a huge one but sizable enough to qualify as big. It employs roughly around 350 people, half of whom are nurses.

Myles is the chief nurse executive. Fred's the medical director's No. 1. They both share this curious situation of reporting to a superior officer who's just a figure head. Myles reports to Lucy who is a 72-year-old veteran of the nursing service; Fred, to Dr. M who's in his late 70's. Lucy got hired because of a mother's dying wish. The CEO's mother, that is. For whatever reason, the mom wanted Lucy in the hospital whatever happened. So she's there. Dr. M's presence is due to his affiliation to the CEO's dad.

Short history

RGH started in the early '60s. It's my age, actually. It was founded by the present CEO's father, Dr. Q. From five beds, the hospital grew to its present capacity of 200 beds. Dr. Q had a group of people around him then: Mr. H, who handled the accounting bit; Drs. M and P, who helped in attending to patients; and Mrs. Q who handled the budgeting, purchasing, personnel, and everything else. The elder members of the Board are some of those doctors who helped out in the early years.

When Dr. and Mrs. Q died, the present CEO took over. His siblings didn't want to get directly involved in the hospital's operations and, since my boss was the most obedient in the family, he agreed to take on the job. Incidentally, he holds in trust for his siblings the majority stock in the hospital.

My boss and his wife

This guy's passion is computers and finance. He has no love for corporate wars and the games people play in the corporate world. Or any other world, for that matter. He's very quiet and unassuming, but he can be determined when he needs to be. He has his own decisions and he sticks by them. That's why I respect him. I see part of my job as making it easier for him to do his. And I do want to help him out as he's such a great guy.

His wife, the present Mrs. Q is just as quiet and unassuming as he is, but she needs more training in people skills than her husband. she tends to be very highly strung. I think it's because she's uncertain as to what she's actually doing and where she fits in in the whole scheme of things. So Myles and I took her to lunch last week.

What do you know? We seemed to have found an ally in Mrs. Q! All she needs, I believe, is people to let her in on the big picture. We promised to keep her updated on the latest.

That was a good move.

Conspiracies

Due to the number of pioneers in top management and the Board itself, the CEO and Dr. P (who is now the President of the hospital and the chairman of the Board as well) had to look for ways to go around the obvious obstacles. They had to be creative.

This much I knew, as the CEO himself told me in confidence on my first day. He made it very clear that there was no way that these dinosaurs from the '60s were going to be fired or retired. I simply had to find a way around them. But it was such a delight to discover that, in this light, little conspiracies abound.

First, the conspiracy between the doctors P and Fred. Although Dr. M was a mere figure head, he still had the power and the authority to appoint doctors to head the clinical departments. Fred didn't have this power. His was more ministerial, overseeing the consultants and the residents, including the details in the operations of the departments. But that was it. He is not the Medical Director. So, to diffuse Dr. M's power, Fred conspires with Dr. P to get projects going. Case in point: this upcoming dinner with 15 doctors who we're recruiting to form part of the quality assurance movement.

Fred's dilemma was to avoid having Dr. M signing the letter of invitation addressed to the 15 doctors. Since Dr. M was the medical director, he had to be the undersigned. And since he would then know about the affair, he would have to be invited. Fred didn't want Dr. M there as he had a tendency to throw a monkey wrench in the works by uttering negative remarks that would sure to sabotage the entire hard sell for quality improvement.

The pioneers in top management have this unrealistic fear that should the hospital impose stringent rules regualting doctors' behavior for quality control, these doctors would leave RGH for the other, more doctor-friendly, hospitals in the city. Fred and I don't think they will; we believe that thay would stay as they benefit from the reputation of the hospital as the leading facility in the region. We believe that the doctors need RGH more.

The solution, I proposed, was to have Dr. P sign the letters in his capacity as President of the hospital and the chairman of the Quality Assurance Committee. The only hitch, I said, was how to avoid explaining the real motive behind it.

I was so surprised to know that Fred can actually speak to Dr. P about the situation frankly. As in, tell the hospital president and chairman of the Board pointblank that we were using his office to go around the medical director.

Aha.

Second conspiracy, that between my boss and myself. This I didn't know existed until Myles told me about it, that I could actually use it. So I did. And what do you know? It works!

The nursing service and I started this project to change the nurses' charting format and their attitude toward the new format. It has become a highly successful project but for one thing: a detractor, of course.

Lucy has been in the nursing profession for more than 50 years. So you can just imagine the fossilized management methods and nursing skills that she practices. No one likes her at all but listens to her and does her bidding because of two things:

1. her age; and
2. her office.

She's second in command after my boss.

This dinosaur has been seeking to sabotage the project since day one. She's turned it into a turf war. She believes that the nursing service of the hospital belongs to her and that no one, especially one with no nursing background, can take it away from her. And she saw her opportunity on the second day of the first batch of the workshop.

Lucy appeared although she was not invited and planted the seeds of doubt in the participants' minds that the new format was realistic and achievable. This, after a wonderfully successful first day where we got the nurses to agree to give the format a chance. We had pilot participants attest to the fact that, after only a week, they had become so used to the format, it was now second nature to them, no matter how many patients they had.

Myles and I confronted my boss with this problem, and proposed a solution: the nursing service to conduct several activities at the same time that our project was scheduled; Lucy to be given assignments for completion at the same time; and for our workshop to held off-site. My boss was only too glad to agree. He was finally seeing results after years and years of in-serivce training and he was not about to let things slip back to the ice age. He actually wanted all three of us to go and see Dr. P at that very moment and talk to him about it. What he was thinking was to confront Lucy about the situation and assure her that no one was after her job.

I stopped him, teling him that it was not going to work. The best thing to do right now was to pretend that things have not changed and that my boss was unaware of her efforts to sabotage me. I didn't need a more desperate Lucy at this point, I told myself. I decided to keep that card for future use, in case of a more desperate situation.

Flirtations

While all this is happening, Fred is flirting with me.

He's not the playboy type, definitely. Myles believes he's never had an affair in his married life. (That seems to be a favorite pastime with the doctors and the nurses around here.) He just likes to flirt, I suppose.

Fred can really give you a look that barely conceals his attraction. What he plans to do after that is not so clear. He loves to stare -- at every part of your body. In my case, he loves to stare at my face and my legs.

For the first time, he's answered my email. I keep in touch with the Committee members, and my own sub-committee members, via email and SMS. Easier that way and less use of paper. Besides, Fred doesn't stay in the hospital. He sees his own patients and conducts surgery at the government hospital where the rates are cheaper for the patient. He's a great guy.

But, like I said, what he plans to do next is unclear. As I keep telling Myles, the ball's in his court. It's his move, not mine.