Opinion | On support, collaboration and the drive for efficiency

It started with a question about a clothing allowance. A counselor in a residential group wants to teach a fifteen-year-old girl to manage her clothing allowance herself. She gets a budget, goes shopping together with the counselor, compares prices and makes her own choices. That is how you learn to budget. But the administration worked differently. The clothing allowance was in a central account, and the counselor had to pay for every purchase in advance and claim it back afterwards, with a receipt for each item and a form that was processed monthly. A pair of jeans in the sales, a T-shirt at the flea market without a receipt: each time, a problem. In the end, everything was bought in one shop, with one receipt. Efficient for the accounts. But what did the girl learn from that?

To be clear: the accounts department does not ask for those receipts out of stubbornness. The clothing allowance has to be accounted for, and whoever is responsible for that carries a risk. But then the question is: how do we stay within those rules and still teach that girl to manage her own money? A prepaid card in her name with a monthly statement might perhaps do both. Someone simply has to ask that question first. 

It is a very specific, small example, but examples like this sometimes tell us bigger things. In care and welfare organizations, there are two ways to look at a process. You can look from the perspective of accounting, catering, cleaning or the HR department, and ask: how do we organize this as efficiently or economically as possible? Or you can look from the front line, from the experience and needs of the counselor, care worker and client, and then ask yourself: what do they need in order to do what they have to do as well as possible?

"Through which lens are you looking?" is therefore the question I am asking in more and more organizations. And what I see is that support services, accounting, administration, HR, catering, logistics, are often very good at that first perspective. They professionalize, they optimize, they attract experts or work with specialized partners. There is genuinely nothing wrong with that. But they often do it from their own logic, from their own rules of efficiency, and not always from the question of what that means for the people on the floor.

The kitchen that decides when everyone eats

Take catering. In many facilities, meals are prepared centrally and delivered at a fixed time. Efficient. Probably cheaper too. But suppose you work in a living group where clients need an hour and a half to be washed, dressed, and ready for breakfast? Then they may not sit down at the table for breakfast until half past ten, and an hour and a half later lunch is already ready.

"Maybe then you have to ask the question," I tell organizations, "are we going to do it from the perspective of cost efficiency, everyone equal, all eating at the same time? Or are we going to look for ways to accommodate individual preferences as much as possible?" That is an equally legitimate question. Just as it is an equally legitimate choice to sometimes opt for the economic model. Sometimes even a necessary one. But then it really must be a conscious choice.

What I experience far too often is that this choice has never been made explicitly. That it has simply evolved so that the kitchen decides when everyone eats, and no one still questions what impact that has on the floor.

In every service, there are people who want to do their work well and are proud of what they build. That applies to accounting just as much as to the living group. And fair is fair: support services often get the blame. When a procedure creates friction, "administration" is quickly blamed. They are rarely told when something does go well. Even less often are they invited to the table when care and support are being discussed. How can you then know what your procedures mean on the work floor? Such decisions often grow organically, without anyone having bad intentions. Anyone who wants to run their service well naturally looks at what they can oversee. If no one explicitly puts that perspective on the table, the logic automatically shifts toward internal efficiency. 

Support as a conscious choice

I notice that this theme is coming up in more and more organizations. In my view, this has to do with the complexity that healthcare organizations face from the outside. Regulations and government expectations are increasing, and services and areas of expertise are becoming ever more specialized. This puts people under pressure. Internal friction then becomes more visible, and interests can sometimes end up opposed to one another. That pressure is understandable, but do not let the choices that follow from it simply happen to you. Make conscious decisions, from a consciously chosen perspective, and explain them.