“Let’s sit outside,” said my wife as we walked up to our favorite Italian restaurant.
“Are you sure?” I asked, spurred by hunger, “how about we take first available?”
“It’s a beautiful night, so let’s sit outside,” she urged.
As we got closer, I could see a number of people waiting near the outdoor dining section, which had been set up with at least eight (now fully seated) tables.
“Wow,” I said to my wife. “They probably add another 50 percent capacity in the summer with all this additional seating. That’s got to be a tremendous burden on the kitchen and wait staff. I assume they have to ‘staff’ up for the increased load.”
“I don’t know about 50 percent,” she said, “maybe 30, but yes, I wonder how they’ll handle it.”
After waiting for at least a half hour (which I did not mind, that was our choice), we were seated outside. It was about 9 PM and we were ready to eat. After opening our wine and telling us the specials, the waiter said he’d be right back. But as we watched him flit about his section, running from table to table — from inside to outside and back again — we could see he’d been stretched thin. After being left to our own devices for at least 15 minutes, it was clear the additional seating was having a negative effect on the service and, thus, our experience.
The more I thought about it, the more I realized our restaurant had succumbed to the classic mistake of successful businesses — forgetting what made them successful in the first place. Just because you are delivering a certain amount of great product or service, does not mean you can deliver 50 percent more without a commensurate increase in the resources dedicated to its creation, delivery and support. Seemingly “contained” businesses like restaurants often avoid this problem because there are only so many tables you can stuff into a finite area but, as we have seen, there are cases where event that useful limitation can be exceeded.
My wife can attest to these limitations better than anyone. As a critical care/ICU step-down nurse for many years, she often felt that breaking point crossed when she had to care for one too many patients, much like a waiter who’s just been assigned two additional tables outside. Something’s gotta give and, unfortunately, that’s usually the quality of whatever care, or service, is being provided.
Of course, your department, the IT department, is discovering the painful effects of violating this principle all too well, as healthcare reform and government mandates lay project upon project on your backs. The team which had been heroes when producing a certain amount of deliverables is recast as villains when they are doubled.
“No worries,” you say, “We have, and we shall, staff up.”
Sure, that is a better solution than not, but we must remember that staffing up the right way, with the right people, takes time — time to find them, time to interview them, and time to onboard them. Fast and furious when it comes to staffing augmentation is usually disastrous. And let’s not forget the fixed and ongoing costs that staffing up entails, for when and if the projects tail off, the payroll does not. We are all seeing EHR-related expenditures throwing some health systems into the red.
What to do? In a word: restraint. In a concept, it’s about not adding tables outside when the restaurant is full and the staff is just barely holding it together. What does this take? Courage. It takes speaking truth to power about what can and cannot be accomplished. In your system, you must speak this truth to the powers that are the rest of your C-suite and board. In an industry-sense, it is about the organizations that claim to represent certain segments speaking truth to the power that is our government, and saying we can go this far and, right now, no further.
It is important to remember that there is difference between what we want (no matter if those things are the most sublime) and what we can accomplish. Lose sight of this and you’ll not only fail to attain the new items on your wish list, but do significant damage to the work that had been proceeding apace. In short, you’ll lose your regulars by trying to stuff in some new projects, some new tables, and you’ll lose much of what you’d worked so hard to gain.