Dysfunction Junction

By the time I left I could barely breathe. The knowledge of where I had been for the past three and a half years set heavily on my shoulders so that I could no longer stand up straight. It crushed my chest so that I fought to inhale and exhale. The smell of it rose like a river of filth under my nose and the dirty truth clung like shit to my shoes. My work environment was toxic and it would kill me if I didn’t leave.

I didn’t notice much at first. People seemed less friendly than they were in other departments of the same organization. People seemed to be working hard and there was plenty to do; data entry that came in a queue of requests for authorization of medical services and phone calls from healthcare offices across the entire state that rang into a queue sometimes 16 calls deep.

I’d worked in the healthcare field most of my life and by the time I transferred to the referral department I had 12 years under my belt. The training was lackluster at best. I was never given any background information about the department or how its function worked with and complemented other departments in the organization. I sat and watched as one of my new colleagues processed requests from a paper printout of part of the queue. She would sometimes explain what she was doing but it was up to me to ask questions and glean any possible knowledge.

Next I would sit with someone on the phones and listen in. The calls were mostly to check the status of pending requests for authorization. Many of the calls were easy—authorization had been given but the patients and doctors offices had not yet received the approval letter—and the call was simply about providing an authorization number. The requests themselves were also sometimes simple. A request for podiatry or massage therapy could be easily approved. But some requests were for procedures that required clinical review or a kind of review by the person processing the request. One had to know what each specific health plan would allow and also what the limitations of each health plan were (as it pertained to the specific service being requested). Some plans covered services or procedures that others would not and the employee working the queue (either phones or data entry) had to know. We had access to the riders of each health insurance plan and the riders helped identify the plan benefits and limitations.

New employees were told the learning curve would be about six months. For many it was longer than that and many would not even see a sixth month anniversary. Turnover was shocking. I saw at least five people come and go during my first year.

Mandatory overtime was frequent and surprising. I’d never been forced to work on the weekends and I thought the union would be able to help and intervene on behalf of the tired and stressed out workers. I learned that there is no union protection from OT and that (according to my colleagues) the union could claim more in dues based on extra hours worked and higher take home pay of staff.

Granted, some wanted overtime and some made a lot of money working OT, I always thought it best to be given the choice. And….why would a department of thirty people working eight hours of overtime each at least once per month not be able to make any headway on the work itself? We could never get ahead.

Management required at least 100 items of work to be completed by each employee every day. It could be 30 phone calls and 70 pieces of data entry or 83 phone calls and 17 pieces of data entry as long as the quantity by quitting time amounted to 100. Staff were assigned the permanent position of either data or phones. All new staff were placed on phones were it was most stressful but also provided the opportunity to learn the most and learn it quickly—a sink or swim kind of experience.

I actually enjoyed the phones (being the consummate customer service rep) and enjoyed talking to medical teams from Seattle to Spokane and everywhere in between. I learned my job and knew it well and found it incredibly interesting. The knowledge base needed to succeed in the referral department was broad and deep and I considered my education in the department to be equal in depth to what is was when I worked at Fred Hutch.

During my third year, with a new batch, of employees on board, and me feeling pretty well settled into the department, I agreed to help a colleague who was struggling. I would switch places with her and go work the data queue. I thought it might be nice to have a break from the constant talking and being talked to of 100 calls per day.
I had a good friend in the department, someone who transferred in just 30 days after I did. We were both being forced out of our previous jobs in Family Practice due to an organizational restructure. We both lamented and laughed about all the absurdities in our new jobs—from the piss poor training to the soul sucking mandatory overtime—to the most obvious and distressing aspect –the back biting and in fighting among staff. We were working in the most dysfunctional department we’d ever experienced. Our immediate supervisor, Gloria, knew very little of the work. If we went to her with a question she would walk us over the Lead who always had an answer. The second supervisor, Latheena, was knowledgeable but mean and seemed to actually enjoy and perpetuate the ongoing dysfunction.

If rules or processes changed , the staff were frequently the last to know and it was usually during a phone call, with a nurse from a doctors office that we would learn of changes in our own criteria. This was a frequent scenario and it left staff feeling angry and distrustful. Another aspect of the work was that if an error was found we were told to send it to the supervisor with the name of the offender. Those who made errors but were popular or feared were not as subject to this as those of us who were disliked or thought of as trouble makers. It’s funny how people will work hard to preserve homeostasis even if it’s destructive and unjust.

In working the data queue and turning in my tic sheet every day I found that I could not always reach the goal of 100 items worked. Some days I came close and produced 88 or 98 and some days only 79 or 80. I turned in my tic sheet every day and documented honestly. During my first review with my supervisor on the data side I was told that if I didn’t get my numbers up I’d be placed on a PIP (performance improvement plan). I worked harder but my numbers did not reach 100 on enough days to keep me from the threat of a PIP.
I began noticing how some people in the department, and one woman, in particular were so very social. Talking and laughing and stopping to chat and gossip at many desks every day and yet she not only is meeting quota but exceeds it every day. She even boasted that if she drank a red bull she could easily work 200 items! Everyone knew she was full of shit. But it was me—not her who was the subject of a possible performance improvement plan. I turned in my sheet every day and recorded my work honestly and with integrity, but clearly this was not happening with everyone.

Since the phone queue was the least desirable area to work but I enjoyed it and was successful there, I asked to be moved back. I only went to the data queue to help someone anyway and on any given day a current phone worker would gladly trade places and take work in data instead. My request was denied. I was being set up to fail and would indeed fail because I refused to pad my numbers.

A few days before giving notice I logged on to my computer and didn’t know what to do. I couldn’t remember my password and froze. I had to open other applications to but couldn’t remember what they were. Was I having a stroke? Was I going crazy? I was under an enormous amount of stress. I took a deep breath and closed my eyes. When I looked at the screen again I was able to proceed and get through the day. In the morning I tendered my resignation and gave six weeks notice. I needed the time to adjust to the idea and to get a jump on job hunting.

I was in free fall. I didn’t care. I could breathe again! The enormous pressure was lifted and I actually enjoyed my remaining six weeks. My former Lead on phones gave me a very nice card and said she’d never known anyone with such exemplary customer service skills and the team gave me going away potluck where almost everyone congratulated me on my “escape.” The supervisor took my company paid transit pass away and I had to ask for enough money from my coworkers to cover the train ride home. The pass could have easily been electronically disabled the next day but it gave Latheena a chance to do something mean and she could never pass up that kind of opportunity.

I enjoyed days of unencumbered freedom. I had enough money to cover my expenses for the month and I knew I’d easily find another healthcare job. What I didn’t expect was to find the job within the organization I’d just left.

I took a two -dollar pay cut and gave up 10 years of seniority. I was now an entry level medical receptionist in a behavioral health clinic. I was no longer subject to mandatory overtime. The work was easy and undemanding. I missed the complexity of my previous job but I was grateful to be out of a toxic and tragic work environment.

My friend remained in the department and has kept me posted on all the sad and ongoing events. The one good thing that came after I left was that staff no longer manually recorded their daily work by using tic sheets. The computer was used to generate a daily report of work completed and the report revealed that no one –not a single person had processed 100 items every day. I felt vindicated at last. Too bad I lost 10 years of seniority and the vacation accrual that goes with it. I’ve reclaimed the two dollar salary loss but cannot shake the memory of what it’s like to work in such dysfunction. I have since witnessed similar evidence of organizational dysfunction in other departments as well. It’s the culture of the company for which I still work. It’s the culture I hope to someday leave and say goodbye to for good. I know it’ll happen soon. I can feel the shit sticking to my boots again. And there’s this odd pressure building on my shoulders….



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