If you call 911 or go to the clinic or hospital, what are you looking for? I would hope to find PEOPLE trained to care for whatever problem I might have. It would help to know they have some experience, regular training updates, quality supplies and equipment, and decent facilities to work in. I’m not just talking about doctors, these PEOPLE may be any type of health care provider, such as EMTs, nurses, medical aides and all kinds of technicians, therapists, and counselors who work directly with people to improve or help cope with health problems. They need to be the kind of PEOPLE who can work together as a team to do what is best for you, rather than what will be good for them or the organization that pays them. You will want PEOPLE who don’t give up easily, and who will do whatever has to be done, no matter how difficult or unpleasant, and keep it confidential. They should be the kind of PEOPLE who you would want to sit with you, when there is nothing left to be done.
Of course, many additional people work in health care in what I will refer to as support services. These are important jobs that need to be done, including: preparing meals, cleaning up all kinds of stuff, laundry, maintaining equipment and buildings, budgeting, keeping records and paying bills, and... yes... that includes administration. What is the difference? These tasks are done in virtually every other building in town, including your own home. Although support services will help patients indirectly, they are not specific to the health problem. To be sure, health care providers could do these tasks (like they do at home), but they do not require medical training, and it would cut into the time available to provide health care.
Are support services important? You bet they are! Most doctors are recruited to work for organizations in part by offering a package of support services that a private medical practice would have to arrange for, or do, on their own.
What is my point? Point #1: Health care is provided by PEOPLE, who are working for you. Not by buildings. Not by machines. Not even by support services, although we can work better with their help. Point #2: Administration is a support service that could be very helpful to health care providers.
The heart of the problem in Wrangell is role reversal, also known as “the tail wagging the dog.” In both organizations the administrations have elevated themselves out of support services to the top of the chart. Instead of participating with the team to deliver quality healthcare to the community, they are absorbed with themselves, their building projects, grants, and computer systems. They are giving little thought to improving the health care provided, but much attention to maximizing the revenue produced.
In the end, health care providers who should be focused on advocating for their patients are instead expected to advocate for the administration and their projects. As health care providers expect to support the cost of doing the paperwork and organization of health care, but not when it expands to the administrator’s personal goals with salaries and employee benefits that aren’t available to health care providers or other support service employees.
Role reversal has also occurred in the relationships between the organizational boards, the administrators, and the community. The boards exist, on paper, to represent the community and bring their perspective to the organization. The board, not the administrator, is ultimately responsible for the organization. Amazingly, they scold the community for daring to disagree, and health care providers, who are asking for a voice in issues affecting health care. The boards allow, or collude, in pouring resources into administration contracts and consultants that do not provide health care and building contracts that have spun out of control. It is their job to employ an administrator to handle day to day functions and provide the supervision to ensure the organization is meeting the community needs. Instead, they appear subservient to their own employee and support peripheral goals at the expense of other responsibilities, such as providing health care.
The boards have allowed their administrators to magnify their personal animosities into dysfunction on a community-wide scale. As a result, organizations that share goals and should cooperate to accomplish them eye each other with jealous paranoia and undercut each other at every opportunity.
The loss of focus on providing health care has spread from the organizations to the community. I hear administrative staff, city council members and our coffee shop analysts referring to Mr. Selle-Rea (and his staff, board, and lawyers) as “The Hospital” and referring to Mr. Walker and his staff as “The Clinic.” Neither is true. They are administrators, a support service for the doctors, nurses, aids, etc. who provide your health care.
Similarly, community members refer to the old, new, and proposed buildings as “The Hospital” or “The Clinic” as though the buildings were the focus or source of health care, but they are not. They are no more necessary than the fire hall is to the EMTs. If they all fell down tomorrow, the EMTs would be hard at work in a few minutes, improvising supplies and equipment. The ER would be up and running in any available space. The hospital and clinic staff would follow close behind with every able-bodied Wrangellite helping wherever they could. That spirit and those PEOPLE are present in Wrangell, but right now they have to wade through this mire to do their jobs as the organizations scratch each other bloody to gain control of the system and the money that goes with it.
It is not the buildings or administration that matters. What counts is having trained people willing and ready to go. The administrations need to rejoin the team. If they can’t do that, it’s time for each board to recognize they are ultimately responsible for this mess, and do their job.
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