Gerotalk : Assisted Living

What Can Long-Term Care Learn From Enron?

Brian Garavaglia — Mon, 30 Mar 2009 17:01:00 GMT

Today, most people are familiar with the story of Enron. A company that was once looked at as one of the exemplary companies in the United States became a buzzword for corruption and mismanagement. Although the problems that came to eventually destroy Enron were monumental, as mentioned it was once viewed as an exemplary company. What happened at Enron is a lesson for those in business and this lesson is transferrable to the health care sector as well.

Enron as mentioned was once viewed as an exemplary company, which was growing and had sound leadership driving its corporate culture. Under Richard Kinder, the president of the company, the company flourished, and a corporate culture of trust was established. Kinder was viewed as a person that was quite meticulous and held others accountable for their behavior and for their roles in the company. Although strict, he did build a culture of trust that many felt comfortable with. They understood their roles and their expectations and although Kinder drew a line in the sand, establishing his area and what his expectations where for others, many felt that he did so without equivocation.

With the movement of Richard Kinder out of the company and Jeffrey Skilling into the role of Chief Executive, things started to change. Skilling had a Machiavellian temperament for control and an unbridled hubris. Skilling introduced evaluation systems that would be made available to others in the company. He also created an environment that found frequent turnover, fostering hegemony and fear throughout the corporate environment. This left many looking over their shoulder wondering if they would be the next person to be cut from the workforce. The environment that had previously been based on a level of trust and stability was now being replaced by a culture of paranoia based on Skilling's capricious and fear-inducing tactics.

Skilling appeared to feel that introducing fear and fostering a sense of insecurity among the workforce culture was a positive management strategy. As the new culture and management style became set in place at Enron, it was almost inevitable that the organizational features that Skilling put into play would led to the formerly successful company to witness a destabilization of their cultural environment. We now know that it did and the stability and trust that was established by Kinder was destroyed by Skilling within a very short period of time. This for sure in not the only problems that Enron faced, which ultimately led to their demise, but the establishment of a "social Darwinism," with a cutthroat mentality and a lack of care for those in their work culture was significantly related to the downward spiral of this company.

So what type of lesson does this hold for those in long-term care? The lesson is significant. In a health care environment, the importance of trust and collaboration is very important. Prior to Skilling's arrival at Enron there was a feeling of consistency and trust. The company flourished under leadership that encouraged a firm management style that emphasized a collaborative and trusting team approach. People were viewed as resources that needed to be tapped. However, when the culture moved to a dog-eat-dog environment, trust waned, collaboration waned and the workers came to view themselves as disposable cogs that occupied positions on a day-to-day basis. How often do we witness this type of style within long-term care?

Think of how often we feel that we need to manage in secrecy, behind closed doors. For sure, there is need for this type of management. But all too often this type of management comes to dominate the administrator or other manager's styles, providing for a less than transparent environment. Workers come to feel that the culture is veiled in secrecy, with workers becoming paranoid about what is being discussed behind those closed doors. This in turn often erodes feelings of trust that are needed for a sound and efficient work environment. Furthermore, a level of hypocrisy often results where managers state they have an open door policy, yet spend most of their days is clandestine discussions or meetings. Workers pick up on these subtle clues that are provided by those in authority.

As we witnessed with Enron, when trust started to erode and when capricious policies were set, the breakdown of trust as well as the breakdown in the cultural environment as being a stable and predictable place eventually led to the downfall of the company. Workers became anxious about their jobs and they also became weary of working in such a strenuous and draining environment. The social Darwinist philosophy of "survival of the fittest," promoted distrust and continuously made workers view others in askance. Moreover, it ultimately led to workers viewing themselves as disposable commodities without any attention being paid to the person's self-worth. All too frequently we provide little attention to developing an environment or organizational culture based on trust. As those at Enron did, letting their profit and loss be the all determining factor that a worker's worth was measured by, many in long-term care fail to nurture the important factors of trust, stability, and security in the organizational environment.

Health care is a business, and long-term care is no exception. Yet, failing to recognize the importance of our human capital, those people that we depend on to carry out the important duties found in long-term care on a daily basis, is critical. If we fail to build a culture based on trust and respect, and fail to recognize that these needs are paramount for those that we manage, we too could face the same type of problems as an Enron. Therefore, rather than look at a company such as Enron and say it could not happen to us, we need to learn and understand how we can obviate such problems from occurring in the environments that we oversee and manage. History does not need to repeat itself if we can learn the lessons that it teaches us.

Changing Brains

Brian Garavaglia — Wed, 31 Dec 2008 15:46:00 GMT

Are you paying enough attention to your residents' cognitive wellness? Read my latest column on the ADVANCE Web site.

Dealing with Problem Work Behaviors in Long-Term Care

Brian Garavaglia — Tue, 13 May 2008 16:17:00 GMT

In the previous article, Problem Personalities can Lead to Workplace Turmoil, a few major personalities and their resultant issues were examined. This paper looks at personality problems, their behaviors, and how to address these issues in long-term care environments. However, before moving forth with this discussion, it must be stated that there are no full-proof ways that always work in addressing individuals with these problems. Yet, there are some major approaches or rules of thumb that can be used to deal with individuals that present these problems in the workplace environment.

In the previous article the passive-aggressive personality was mentioned as individuals that often engage in passive activities such as tardiness, lateness, procrastination, and obstructive efforts that are very disruptive to the workplace. What is interesting is that these individuals often enjoy the frustrating reactions that they provoke in others. These individuals will frequently manifest these types of negative and obstructive aggressive activities very early after being hired. However, because of the insidious nature of their aggressive behavior, failing to demonstrate the overt features of many forms of aggression, many individuals fail to pick up on the destructive nature of this type of behavior until it is too late.

Essentially, being aware of how aggression can manifest itself on a passive-aggressive level can be instrumental in ridding the workplace of individuals with these types of traits before they become part of the entrenched working environment. Since many long-term care environments are unionized and membership often is solidified after 90 days, picking up on these individuals early and weeding them out of the environment is imperative.

Furthermore, as was stated, these individuals often thrive on the response that they provoke in others. The reactivity from others that they achieve from their passive and obstructive aggressive activities feeds their personality needs. Although it is easier said then done, failing to be reactive, and failing to be taken into their manipulative web of passive aggressive tendencies often thwarts what they lust for most, the frustrating and over-reactive response from those that they aggress towards in a passive manner. Therefore, being firm yet non-reactive, will often help to address the concerns that this type of personality poses.

The narcissistic personality, often coming off with an over-inflated sense of self-importance, has a very fragile ego that often attempts to avoid any type of issue or event that may challenge their sense of self-worth. Their grandiose sense of self and exalted since of entitlement makes them an utterly individualized entity of pomposity. Here again, they are destructive to the larger team environment. They need to be reigned in quickly and their behavior addressed.

However, in addressing these individuals, it becomes imperative to not become overly confrontational. When this happens their delicate sense of self becomes insulted to the point that they lead a counter-attack against the person that is confronting them. They fail to listen to anything that is constructive and react to the apparent threat that is posed to their fragile sense of self. Therefore, addressing their behavior aggressively and confrontationally will only lead to a lose-lose conflict, leading to nothing productive for either party.

The paranoid personality is the third personality type that was mentioned in the previous paper and will again be addressed here. Their widespread suspicion of others, and their lack of trust make them a formidable challenge. Their maladaptive suspicious nature makes them feel that they are always needing to be on the defensive for fear that someone may unduly threaten them in a myriad of ways. Their lack of trust in their environment makes them react with accusations against others that may range from racism or sexism, to harassment or imputed violent accusations. Please do not mistake or misconstrue these statements.

I am not saying that all individuals that make these accusations as such have a paranoid personality. However, those with a paranoid personality will often assert these accusations when no firm reality basis for their existence. They engage in an autoplastic adaptation, which means that to deal with these perceived psychical threats they alter their perceptions to fit their ill-conceived mental constructs.

In dealing with the paranoid personality, one has to avoid engaging in a confrontational battle of trust. Since lack of trust and suspicion are the catalyst for their worldview, it becomes difficult, if not impossible, to make them the trusting team player that you need for success in your long-term care environment. It is often a terrible reality, but these individuals are often a highly litigious threat. They are just a slight push or pull away from filing suit over some issue. They need to be closely monitored and all your "i"s need to be dotted and your "t"s crossed in dealing with them. This is not to say that all individuals that present themselves in your organization with this type of personality will inevitably lead your facility to court. However, depending upon the level of their personality issues, the probability for such behavior does deserve watching and may even entail the need for frequent legal counsel to help address many situations that they will bring to your attention.

It becomes apparent that there are some very interesting, yet challenging, personalities that can wreak havoc on the long-term care environment. This paper reexamined three personalities from the pervious paper, but it looked at some further consequences as well as brief strategies of intervention that can be used to address these personality issues. However, this brief article far and away fails to provide a voluminous array of interventions that can be used. The topic and its complexity fails to lend itself to a complete discussion in the limited space available for this article. That being said, the reader should still be able to come away with a general knowledge and some rudimentary skills that can better enhance their ability to deal with these problem individuals as they arise in their long-term care environments. It is my hope that the reader will come away with a better understanding of individuals with passive-aggressive, narcissistic, and paranoid personality traits, as well as how to address these individuals and the many challenges they may present in long-term care settings.