Intentions and impact

After we had dropped off our bags at our guesthouse we drove to the hospital where the small rehab center is located. We found all four staff there, two of whom I trained in Lome in June, to become better ‘managers who lead’ and make their center more efficient and effective. After I had the tour of the premises, simple but orderly, and more spacious than the center in Niamey (but with way less patients) – we sat down to discuss the baseline data they should have had collected and sent to me more than a month ago.

The instructions and excel sheets they should have filled in are on a flashdrive, given to the participants back in June. Flashdrives assume one has a computer to download the files on, and, at a minimum, to view them. This, we discovered, had not happened. The woman in charge of the center does not have a computer at work – there are no computers at all. But she had one at home which is now gone with her son who is studying in Morocco. She had mostly forgotten what had been delivered in a long monologue using powerpoints by the chief from Geneva. This of course was no surprise. Powerpoint-driven monologues don’t teach – we know that, yet we keep thinking that one day they will.

The project also asks teams to use a participatory organizational assessment of management systems that is developed by my organization. If in Niamey many of the items to be scored were irrelevant because the center is part of the hospital and management processes are run by the hospital, not the center, here this is even more so the case. The center’s manager had scored everything, on her own. We explained that the idea was to do this with others to help people see the whole as opposed to only seeing what happens in their own department (usually adequate) and what happens in other departments (nearly always lacking).

The idea of the three year project is to collect baseline data now (time and cost of making a prosthetic arm or leg, number of patients, use of raw materials, wastage, staff productivity, etc.) in order to determine two things: what should be the focus of the efficiency and impact improving intervention, and to be able to compare at the end of year 1,2 and 3 whether there has been any improvement.

Like other projects, the idea is good, but the conditions on the ground mess things up. Here we reviewed all possible interventions, not necessarily based on data (since they have not been collected) but on common sense about what is and what is not possible. We are aiming for (very) small victories.

In a steep hierarchical organization, where the boss is The Boss, leadership at lower levels, by people who are physically near The Boss, may well be a good theoretical idea, but not all that practical. I listened to the stories of how powerless people actually are when The Boss wants something.

I learned that technicians in prosthetic and orthotic workshops are excellent fixers. They can fix any broken equipment. The Boss likes this and sends any broken equipment from the entire hospital to the rehab center to be fixed by one of the four employees of the center – the one who makes the artificial limbs. This distracts from the work he is hired to do, but he can’t say no to The Boss. Nor can his boss, the woman who runs the center. Is it because she is a woman, I asked? No, not that, one simply cannot say no to the The Boss. I was thinking of my experience in Madagascar with the folks who were far from the center being able to take on a leadership role in their community. I now realize it is because The Boss there was very far away, and never showed his (or her) face. But here, where The Boss is close, it doesn’t work that way.

They do find ways to work around it. For example, Mr. Fixit now says to The Boss that he has tried but cannot fix it, a white lie, but effective. Or he makes the problem worse, a kind of organizational sabotage that doesn’t really serve anyone, but what else can one do?

Being here in this faraway place makes me think about what, of all the lofty intentions that we state in reports and proposals, we can actually do. We are one more of those signs on the road that clamor to deliver on promises and make lives better, but we too may find ourselves a rusted sign in the cemetery of failed or incomplete projects.

My philosophy has been to help individuals become more confident and, as a result, assertive and give them some concepts and tools they can use in their advocacy for humanizing workplaces and reducing stress. That’s really what coaching is all about and that is why I think coaching will make a bigger difference than anything else. And so I practice my coaching, not always successful, but I am learning from my mistakes.

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