Does Work Level Elitism Cost Lives? Covering All the Bases

By Michelle Malay Carter on January 16, 2009 

Multiple Levels of Work Going On HereIn a study published in the New England Journal of Medicine found that when a procedural checklist was used in surgical operating rooms, death rates dropped by one half and serious complications fell by 36%.

More Complex, Not More Important
Using a requisite work levels framework, following procedures is the essence of the work at level 1.? It is the least complex type of work.?

Elitism?
When?I am teaching about work levels and explain them in a hierarchy, some participants wonder if I am being elitist.? Some conclude that because I say that work increases in complexity as you rise through the levels, that I am also saying that higher levels of work are more important or somehow better.

Organization Design – Delete Levels at Your Peril
My response is that all levels of the organization have a role to contribute.??Delete a level at your peril.? I wouldn’t want to work for a business unit that was missing, say, level 3 work.? (This is the layer that is often missing in flat organizations.)

How Did the Medical Field Miss This Simple Solution?
We are all drawn to work that matches our level of capability.? Conversely, we tend not desire work that falls above or below our current capability.?

My hypothesis is that operating rooms are staffed with people whose capability is beyond level 1,?most may be?well beyond level 1.? Hence, no one is interested in following a procedural checklist, but this research study shows that there is critical level 1 work to be done in the operating room.

Using Work Levels Theoretical Knowledge to Design a Solution
We all have tasks we must do in our roles that we do not perceive as “the good stuff”, and these tend to be tasks that do not challenge us.? So, we can assign the procedural work to those already present in the operating room who may not value it,?or we can add a level 1 position to be present in the room and that person’s role is to specifically check the checklist and prompt others to perform tasks on the list that are missed.?

Each solution has pros and cons.? In the case of airline pilots, the cockpit simply does not allow additional bodies to be present, so the pilot and co-pilot are accountable to do the level 1 work.? (By the way, kudos to the USAir pilot who landed his plane on the Hudson, not in the Hudson.)

Organizational Design
The point is that there is critical level 1 work to be done in the operating room.? When it’s missed, people die.? Hospitals must design their system to facilitate this reality.

I’m OK. You’re OK.? Let’s fix the system.

Your thoughts?

Filed Under Accountability, Organization Design, Requisite Organization, Talent Management, Work Levels

Comments

2 Responses to “Does Work Level Elitism Cost Lives? Covering All the Bases”

  1. Jim Schultz on February 2nd, 2009 11:34 am

    Michelle,

    As always, enjoyed your input…RO has made me appreciate and realize the contributions of all roles in my company.

  2. Michelle Malay Carter on February 2nd, 2009 6:59 pm

    Hi Jim,

    Thanks for stopping by and for the encouragement.

    Regards,

    Michelle