Policy violations

A friend who is a nurse just told me this little story:

Medical Records of a hospital in another city
We require a signed form to release patient data.

Me
But this is for continuing medical care. A signed form isn't required by law.

Medical Records
We require it anyway.

Me
I need these records. It's important. You really want me to have an 89 year old patient rush here to sign a form?

Medical Records
Yes.

I hang up, call the LA hospital main number and request to talk with the charge nurse at the cath lab.

Me
So, I need these reports and I can't get a patient release, can you FedEx me a CD with the echo and cath studies?

Other hospital's charge nurse
You bet! I'll get that out to you today.

Healthcare in this country seriously wouldn't work without the magical-nurse-to-nurse network!

This reminds me of another story, told to me by an occupational psychologist I once interviewed for a project. He told me about how he was doing an project about the housekeepers that work at super-luxury hotels. So he was interviewing one of these super-housekeepers, and he described this dialogue:

Psych
So what is the last thing you do before you leave the room?

Housekeeper
Um. You said that you won't be telling my boss about what I say in this interview. Is that really true?

Psych
That's right. My report will go to people on the executive team, not your boss, and will combine what I learn from you with several other people I interview. Nothing will be attributed to you.

Housekeeper
Can you promise that?

Psych
Yes.

Housekeeper
Because I could lose my job.

Psych
I promise. It's part of my professional ethics and my agreement with your employer.

Housekeeper
Okay. The last thing I do is I lie down on the bed.

Psych
That's interesting. Why?

Housekeeper
Because there are things you see from there which you don't see from anywhere else. And it's often one of the first things the guest will do when they get into the room after a long trip.

Psych
I see. How is your boss knowing about this a threat to your job?

Housekeeper
I'm not allowed to lie on the bed! There's an explicit rule about that: no employee may ever lie on a guest's bed.

Psych
But you do it anyway.

Housekeeper
If I don't, I cannot be sure that the room is clean!

Doing design for business process software, I am often told by the sponsors of those projects that the advantage of those systems will be that policies can be strictly enforced. But every organization works, in part, because people violate policy out of their sense of professionalism.

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Updates:

• bOING bOING has a collection of links to resources showing that healthcare workers prioritize helping people over information security, because of course they do.
• Op-Ed in HindSight 25: Malicious Compliance

  Understanding how daily success is created – how work is actually done – can help reveal where the next potential adverse outcome might come from. And it can do that much better than investigating the highly infrequent failure.

• Marina Nitze, Nick Sinai, Hack Your Bureaucracy: Get Things Done No Matter What Your Role on Any Team (MIT Press 2023)
• A reader points me to Barry Schwartz writing Rethinking Work the New York Times:

  What about the janitor? The phone solicitor? The hairdresser? The fast-food worker?

  I submit that they, too, are looking for something more than wages. About 15 years ago, the Yale organizational behavior professor Amy Wrzesniewski and colleagues studied custodians in a major academic hospital. Though the custodians’ official job duties never even mentioned other human beings, many of them viewed their work as including doing whatever they could to comfort patients and their families and to assist the professional staff members with patient care. They would joke with patients, calm them down so that nurses could insert IVs, even dance for them. They would help family members of patients find their way around the hospital.

  The custodians received no financial compensation for this “extra” work. But this aspect of the job, they said, was what got them out of bed every morning. “I enjoy entertaining the patients,” said one. “That’s what I enjoy the most.”