Archives for December 2010

In our quest for efficiency, we have created a culture that venerates the assembly line and convenience.  Corporations, small business and even workers believe it’s best to do business in the way that’s most efficient, streamlined and convenient.  If we’re talking about manufacturing, I have no quarrel with streamlined processes.  If we’re talking about taking care of children and the elderly, or even the service industry, we get into some trouble.

I used to cook in restaurants for a living. Cooking is what’s known as a “back of the house” function, serving is “front of the house.”

In the back of the house, you can’t afford to waste a movement.  You use your whole body to get things done, your foot closes an oven door, your hip a refrigerator door, your elbow nudges something teetering on the edge of a counter, your hands are a flurry of flipping and stirring.  Your senses are engaged to make certain you know the status of each piece of food and order you are handling.  Customers are faceless; reduced to tickets in a window or text and numbers on a screen. 

I’ve worked in the front of the house, too.  Yes, you must be efficient, but you must “waste” movements.  You may have set a path for yourself to lead you from task to task, but a customer with a need should always be your first priority, or there goes your tip.  Customers get testy if they think refilling a salt shaker is more important than refilling their soda. 

In both cases, your ability to make money is through serving the customer, but when the customer is right in front of you, your focus is much different.

And here lies the problem with some institutionalized care.  Nursing homes, daycares, schools: they want the ruthless efficiency of the back of the house, they forget their primary function is to satisfy their customers.  This could be true in either for profit or non-profit organizations. 

Once, while using a restroom in a community center, I witnessed something I fear is a common scene.  A line of about ten preschoolers were brought in by a care provider.  The care provider was cranky, the kids were squirmy.  But, squirming was not tolerated.  You would have thought they tiny military recruits.  The care provider yelled at them to keep the line straight, stay still and be quiet while she helped each child use the toilet.  The children looked miserable.  The care provider’s goal was order; it should have been a happy group of children.  There are many ways to accomplish a somewhat orderly toilet time without resorting to meanness and shouting.

A number of years ago, PBS featured a documentary called “Almost Home” which told the story of a nursing home in Wisconsin.  The director there looked at the standard nursing home model, where residents are forced into a schedule of activities in a cold looking environment and said, “No more.”  He realized the facility was set up for staff convenience, not the comfort of those who must live there.

Patient rooms and bathrooms were re-modeled to look more home-like.  Residents could choose to do what they wanted, when they wanted, just as they would at home.  They could choose their food through a menu of options.  Basically, the nursing home was completely re-geared to actually serve the elderly.

Staff attitudes are often the biggest obstacle to this type of organizational shift.  Instead of doling out meatloaf at 5:30 sharp, the nursing home food service staff must now make food to order any of time of day. The community center is a non-profit organization with the goal of helping people, but the ornery care provider lining children up against the wall has her own agenda.  She wants to get through the work day with as little inconvenence to herself as possible.  It takes some convincing to show her there’s a better way.  Organizations have to work hard to show employees what’s in it for them.

Anyone who has taken care of a child or an elder knows that efficiency is something only sporadically attainable, and often at a cost.  Care for another being is so much more than completing a series of tasks.  As a culture, it’s time we start demanding institutions that forsake efficiency and honor the individual.