Teams are living things …

As managers, we are sometimes so concerned about the outward signs of effectiveness – whether all the boxes have been ticked – that we often don’t notice that our employees are just going through the motions. For real effectiveness, and a staff that actually enjoys coming to work, we need to manage from the heart – for the heart.

Zombie CPR

If you’ve done a CPR course lately, you’ll know that they no longer teach you to feel for a pulse. That’s because non-medics are useless at feeling a pulse – especially when they’re in a panic! So now you are just taught to look for ‘evidence’ of a pulse – if the heart is doing its job, the person should be moving and breathing. These are ‘signs of life’. If the patient’s not moving or breathing, they have no signs of life and we assume their heart has stopped, so we ‘get onto the chest’ and start cardiac compressions.

Now imagine that someone is down. We check for signs of life and there aren’t any of them. But, instead of getting onto the chest, we grab an arm and wave it around – et voilà, we have movement, and the person is saved …

… oh come on, that’s silly! But in management we do the equivalent almost every day.

Signs of life

Indeed, this analogy came to me when one of our EMS staff members got drunk on duty and ploughed into an on-duty police car. I was sitting with a group of managers who were chatting about the event, and one of them pronounced confidently that ‘people need more supervision’. I was a little gob-smacked, especially when I saw all the rest of the managers nod in grave agreement! Having worked in various parts of the health service and other businesses over the last three decades, I had experienced EMS as one of the most supervised organisations ever: staff come on duty and stand on ‘parade’ as their uniforms are scrutinised, their arrival times are watched (and punished if late), their vehicles are tracked, and their radios monitored. These are adults who pastor churches, maintain households and run small businesses in their off-duty hours. I don’t think adding more supervision – more layers of ‘movement’ – will solve what I perceive to be a problem of the heart.

So I challenged the managers: ‘We don’t need more supervision, we need more humanity. More heart. We need to ask ourselves: What could have happened that a reasonable, rational, dedicated adult would have thought it was okay to get drunk on duty? How often has this happened? How could we have picked up that they had a problem? Also, what was going on with his partner (our ambulance crews work in pairs)? Did she know? What was happening with her that she didn’t stop him … if not from drinking, at least from driving?’

Taking the case to disciplinary would ensure that this particular individual never did that specific thing again. We could also create more rules clarifying what’s okay and not okay – as if this one was ever in doubt – and we could even bring in breathalysing (with the requisite personnel and equipment), but that wouldn’t address the individual’s underlying trauma, which was most likely acquired on the job, and is more than likely the root of the drinking problem. It would also not start to address the systemic issues that led up to that particular event, and are continuing to breed widespread patterns of apathy, trauma and inhumanity in our staff: people who came into this work because they have a heart for helping people at the most vulnerable times of their lives. In essence, we’d be responding to this crisis by creating more ‘movement’ and hoping that this would bring back the heartbeat.

Unhuman resources

To continue with the analogy, if we persist with ‘add-more-movement CPR’ as our management philosophy, the best-case scenario is that we end up with a dead body. The worst-case scenario is that we end up with some sort of zombie: they’re dead, but now they roam the streets looking for people with signs of life whom they can suck dry. Those who have been deadened (and hardened) by our unhuman system end up being promoted, and managing people in the only way they’ve ever been taught, with their own accumulated trauma to boot, and trapped in the system they so desperately wanted to change when they first started. And so the zombie production line continues.

Zombie managers are everywhere

This is not unique to EMS. We see this all over the management world and even society: we react to outcomes and try to treat those, without examining what the underlying system is that is so reliably producing those outcomes. When something goes wrong, we blame the individual, make more rules, and train more people to enforce those rules, instead of trying to figure out how our staff are being set up to fail, again and again and again, by the system in place. And, more importantly, we fail to see the humans that make up our ‘staff’.

It’s repeated as if it’s gospel that we should ‘leave your home life at the door when you come to work’ and ‘emotions don’t have a place here’, as if we are machines that can be turned off and on. We look at performance, but not really at the person performing. We have whole technological systems set up to monitor clocking in and out times, and when someone comes in late, we are more likely to dock their pay or give a warning than to make sure that we have coffee ready – made just how they like it – as they’re obviously having a difficult morning. With a management mindset that was established in the industrial revolution, we treat people like cogs in a machine, to be adjusted as they fall out of alignment, to be replaced when they become broken, to be precision-engineered by an elite group of ‘engineers’ who produce standard operating procedures that are then diligently monitored. We lose out on the creativity, drive and humanity that each person, and team, could bring to their work by systematically designing these elements (or the environment in which they’d thrive) OUT of the work, and then we wonder why our machine keeps breaking down, or is not performing as well as the competition.

Time to resus our systems

The reason I feel so passionately about all this is that, as a young doctor fresh from university and eager to change the world, I very soon felt I was trapped in a system of unhuman management practices, maladaptive interpersonal dynamics, broken processes, a crazy demand burden, and a mindset that treats individual mistakes as character flaws. I had the life sucked out of me, and I became someone I hated. It was a daily struggle to reconcile the horrible feelings and behaviours I had towards patients and colleagues with the person I knew I was at heart. The journey back to humanity and vulnerability was hard.

All emergency clinicians know that CPR done on an older person, with their hardened bones, if done right, may break those bones (not purposefully, I need to add!), so if we do get the heartbeat back, our patients can feel very bruised and battered. The ‘coming alive’ process is extremely painful, and the staying alive possibly equally so. It requires daily courage to remain vulnerable, maintain healthy boundaries, push on with hope while remaining realistic about what we can achieve, and strive to see the good in everyone. The good news is that, while it’s true that zombies can create more zombies, live people with heartbeats can also create (or at least sustain) more live people.

And why do we want live people? I would hope that for most us, having happy individuals who feel as if their work and workplace give them a sense of worth, belonging and purpose would be reason enough. But if you’re not there yet, perhaps this will help: studies show that staff who are respected and treated as if they can be trusted not only show themselves to be worthy of that respect and trust, self-fulfilling prophecy-style, if you will, but also end up giving double in productivity – a serious competitive advantage for any business. Back to the CPR analogy: if we want more productivity, movement, etc., we need to work on the heartbeat, and movement will happen spontaneously and will continue as long as the heart continues beating. But just wiggling the patient’s arms about is not sustainable, and will not start their heart beating.

On a daily basis, my team and I are seeing the magic that comes when we work hard to see the person and set up human-centric practices and behaviours, and we are so excited to see this spread. As we’ve worked in EMS, we’ve come to realise that many of the ailments that we see in our system are present in other organisations – and society as a whole – and we’re excited about how learning more about ‘being human together’ has such promise for our work, communities and the world!

Hard truths

Unfortunately, administering CPR in the real world does not have the success rate it has on ER and Grey’s Anatomy. More than 90% of people whose hearts stop, and have CPR administered, don’t end up having their heart start again. So we may ask why we spend so much effort on training and doing CPR. The answer is because, even though the chances of getting the heartbeat back are minimal, it’s the only chance we (or they) have. When we start trying to manage from a heart-centric, or human-centric, perspective, it can take huge effort, change and self-discovery. It will challenge traditional power bases, mindsets, practices, relationships, and your own self-image. It’s exhausting and painful, and takes so much more from you than just writing up another SOP or audit, and it may fail completely. But it’s the only chance we have!