Please offer any advice

[Lynn]

Hi all...

I have a situation that I have been waffling over and I would really appreciate some opinions/advice on how to proceed.

Situation: tomorrow I have an employee review. I am fairly confident that everything will be fine from them towards me as my performance with the company has always rated me the highest marks and raises in pay. Nothing has changed in my performance, clients write beautiful cards and letters about my care. I like the people running the company on an interpersonal level. They are good people, from the owner of the company on down.

There is the moment in the review when I am asked if I have any questions or concerns. I do have some serious concerns. They are substantial in that I have direct knowledge of several instances where other caregivers have provided severely inadequate, potentially harmful, care. The real issue here is that the company is playing a little loose with who they hire, their qualifications, and matching caregiver abilities to the level of care needed to certain medically sensitive clients. In other words, they are legally smudging lines of care in order to obtain clients by promising competent, trained professionals but the caregivers they are sending to these clients are not even certified by the state. I usually end up relieving these caregivers and have, in several instances, had to do triage because medical issues weren't addressed and the patient needed treatment yesterday. In the most severe instance, the caregiver provided such inadequate care that the patient actually was at risk for dying because they weren't supposed to be receiving liquids or food and the caregiver had been trying to force slushy down them earlier in the day.

Dilemma: Do I, or do I not, state this concern? Why the waffle? Because I do not intend to stay with this company much longer but they are one of two work references I have at the moment. I've only lived here for two years and have been with this company since it opened a year and a half ago. This would be a stellar reference. The company, so far, is well thought of in the community.

If I state my concern I am afraid that red flags will be raised with them that I am a potential whistle blower and I will start to get into some trouble. There isn't anything they can legally point to that would be cause for firing me, but they can stop giving me clients. They might try to drum up *something that would make me look bad (what, I haven't any idea) and I'm afraid that they would try to make it hard for me to get a good reference. In the best case scenario, they would acknowledge that this is happening (which they might have done since, in November, I noticed that they let several caregivers go) and tighten things up.

At stake here are two issues: one, I do have direct knowledge that they are running loose legally with what they state is the level of care they provide and the reality of what they are actually providing. Do I have a responsibility to report them to someone?

Two, the biggest concern for me is for the clients. My heart just breaks when I see these things happen. I am very concerned that someone will get seriously injured, or worse, due to inadequate care. Something awful happening would bring the company to the attention of the authorities and then this would all be addressed...but at what cost? Someone's well-being, or someone's life? That is a very high stake.

WWTBD? WW all of y'all suggest?? Am I being a complete git in this case? Should I speak up and forget any concerns to myself?

Help?

In Gassho~

*Lynn

[Fuken]

Lynn,
When I see something I know is wrong (for example: against company policy/ rules/regulations) I always tend to point it out immediately, as long as I can do so legally, as breaking the law (for example: speaking out against a commander in chief while in uniform as that would be against policy too.) I can not seem to help it and it is usually pretty spontaneous. I guess it is in my nature.

There may sometimes be instances where the law is wrong or unjust, but I am only in a position to do anything about that rarely.

While I am not thinking much about references now, Or getting fired, I have also not received a promotion since May of 1999. But I have a clear conscience, and rarely have lost rest over a decision I have made to call someone on the carpet to be held accountable.

This may not help, but I think you can see what I would do.

In Gassho,
Jordan

[Undo]

Hello Lynn,

Is there anyway you could suggest group training or refresher courses for staff members? Maybe the company could then advertise their staff have the most up to date qualifications and so hopefully turn around any costs of training back to profit. This would also mean you do not have to point the finger at anyone in particular. Failing that maybe they have personal development policy and you could suggest to the not so good staff they include training when they have their meetings. perhaps on the lines of improving their CVs.

If you looked at the worse case scenario then someone losing their job is better than a patient dying or becoming very ill.

All the best for tomorrow whatever you decide,

plankton

[louis]

Hi Lynn.

Politics is local indeed! Given the personalities involved, what is the most effective means of delivering a message? Personally, I have always found the informal route best, and seldom (once) used a review to deliver a message.

Office politics gets labeled as Machiavellian, but it can also be about empathy. Figuring out peoples strengths and weaknesses and then helping them. Sell an idea based on how this helps someone else and they will champion your cause too.

I assume your boss or HR coworkers also get reviewed. For someone, having a screwup due to poor care is also a stain on their career. Perhaps you could suggest internal continuing education, a seminar on what can go wrong and how to fix things or manage risks. Who could you help at work by helping make this happen?

Now go buy then a cup of coffee, ask them how they are doing and listen.
Then go back figure out how to sell them few days later and pitch them on how you can help.


I like and have used the recommendations in Influence without Authority, it is an expansion on the above ideas. Also take a peek at http://www.bnet.com/2403-13070_23-93243.html

Finally http://www.amazon.com/Hope-Not-Method-G ... 076790060X, by a former army chief of staff. It is one of those strategic leadership books , but he raises an interesting point on getting meaningful feedback up the chain of command. Give the people beneath you the latitude to admit mistakes without retribution. In this way senior management will get honest feedback of how their training methods are working. Hearing about the screw-ups is far more valuable, every strategic plan has mistakes and good feedback allows it to be modified for the better.

I hope all my procrastination from my day job helped.

-Louis

[louis]

I noticed that they let several caregivers go

Perhaps HR is having trouble finding qualified people, it looks bad on whomever hired them in HR to turn around and let them go. Maybe help that person find good people. Just a thought.

Whatever you decide, good luck tomorrow. We are in your corner.

[Rev R]

I say that if the quality of care is a concern to you then that concern needs to be voiced.

If that voicing leads to a problem for you, then it may be time to move on to the next thing.

[Eika]

Hi, Lynn.

From the information you have given, I agree with the others that you should express your concerns (as diplomatically as possible). There is little room for incompetence in any medicine-related field, so if you see it, I think you should report it. Put another way, if others are being harmed or neglected (or potentially harmed in your estimation) you should at least raise an appropriate alarm.

Another selfish consideration: If, by chance, one of these coworkers contributed to someone's death in the future because of the issues you cited, you would carry a heavy burden of guilt (not to mention legal issues if the company were sued and it came out in deposition that you had previous concerns but did not voice them).

There are other always other jobs, no job is worth abandoning what you think is right.

My two cents . . .

Bill

[Lynn]

wow...thanks to everyone so far!! I'm getting narrowed in on what feels like the best thing to do. However, anyone else, please feel free to add whatever seems good. I'm still fence sitting.

Regarding the in-house educational component: This is yet another aspect that I feel uneasy with. Clients are told that all caregivers attend mandatory monthly educational classes. In the 18 months I've worked for the company; and that is the full 18 months they've been in business; they have not offered a single class. I'm just waiting for a client or family member to ask, "So, what kind of classes have you attended?" Then I'm forced into a very sticky situation, indeed.

Again, thank you all for your help. I appreciate it more than I can say.

With deepest bows,

*Lynn

[Jundo]

This is, of course, a dilemma. No one clear "right" course, pros and cons on all sides. Dangers each way. Ah, such is life!

As with all tough decisions, your heart will tell you what to do ... as much as your brain will weigh the ramifications. In fact, I bet you already know pretty much what you will do (most people do when they ask for this kind of guidance, and are just seeking support and confidence).

The Precepts simply guide us to act, as best we can, in the way our heart tells us is most helpful and healthful, and avoids harm, to our self and others ... knowing that there is no ultimate gap between our self and others. But, from that point, we have to stick our finger in the wind and take our best educated guess.

If you go one way, folks may loose their jobs, if you go another way patients may suffer.

You are also left to weigh your self interest versus the interests of others. Buddhism heavily weighs the interests of others over that of the self, but that does not mean that you should commit self destruction for your self and your family. It is a dilemma. There are battles were it is necessary to jump on the grenade, others where you need to run and fight another day. This is perhaps the toughest balancing act, and you must find the path here.

Now, speaking from a practical solution, is there some way to phrase this for your bosses as potential legal liability? Companies understand that, and tell them that your concern is both patients and the best interests of the organization. Phrase it in a way that they will understand that you have seen risks and that can mean financial loss plus pain to patients. You might be able to accomplish your purpose AND come out a hero. Also, if it comes to it, I am wondering if Washington State has some confidential "Whistle Blower" protection if you were to report this to an outside regulatory agency? You may want to consult with a friendly lawyer in Washington on this and see if you can make a confidential report. Many states (and Washington is a pretty progressive one) have laws to protect confidential reports just like in this case.

Hope that helped.

Gassho, Jundo

[soitgoes]

Would it be an option to voice your concerns anonymously? For example, you could send a detailed letter to the person you trust most in the company, and see if anything changes. If not, you can always try out other possibilities.

[louis]

Hi Lynn,

I reread your post after seeing everyones comments, I missed the part where you mentioned that someone could have been seriously hurt. The tone of my replies did not reflect the gravity of your entire message.

While I advocate the approach I wrote about, it is a long-term view and does not address the crux of your problem if someone is in immanent danger. The liability question Jundo raises is something that I have also found effective and have gently raised from time to time with either operations or internal legal people, but in my case, this is never a question of personal harm, just monetary.

Anyway, I hope its evident that I am still in your corner, if I can help in any way, you are more than welcome to reach out.

[Lynn]

Again, thanks to you all for your sangha wisdom.

Just to prolong my suffering, they rescheduled for tomorrow. :?

I have a Plan A, but am totally aware that, when sitting in the actual situation, I will have entered a flow that may dictate coming up with a Plan Q on the fly. There is the ideal and the actual, as ever.

I will let you all know how it went. I truly don't know what I will say, but, with meditation in motion to guide, I think I will be able to find the Middle Way.

In Gassho~

*Lynn

[Ankai]

Do I, or do I not, state this concern?


I just got out of the Army, so let's try this analogy...
If you and I were in the desert, and you saw a guy sneaking up on me, but couldn't tell who it was... friendly or enemy... would you say something or keep your mouth shut?
If you saw a guy in our unit stealing from my locker, would you tell me, or protect him?
If you saw a guy swiping my ammo before a mission to hide the fact that he'd forgotten his own, would you tell me, or let me leave the gate inadequately equipped?
Assuming the answers, I'll add one more question: if you were th employer, and someone else were aware of the situation, would you be more upset if they told you or failed to?
The company and people recieving care deserve thr truth, in my own humble opinion.

[PapaDoc]

I know that I am late to the dance but the way you present the issue suggests the answer that is internal. The struggle indicates a healthy polarity in your decision making but the spirit within you as a health care professional comes through to me. I am interested in hearing how it goes today.
David aka PapaDoc

[Lynn]

UPDATE:

Well, my motto for a long time has been: The Universe is self-correcting. And, indeed, once again this has been proven!

I went in, got the sterling review, the pay raise, and then, before asking me for my feedback, I was told that they want to move me up within the company into a supervisory role on the newly formed "Safety Committee." This Safety Committees tasks will be to oversee and ensure the safety of both clients and caregivers, as well as making sure all legal guidelines of care are being followed through the appropriate match of client with a caregiver's abilities and training. The first meeting is later in the month and they asked me to bring any and all suggestions I might have regarding this matter with me to put on the table to start the discussions.

They then asked if I had any feedback. I told them that I was delighted, I accepted the new position (which doesn't conflict with also doing caregiving) and I would be happy to offer my suggestions at the first meeting.

Soooooo....how's that? All and all you could have knocked me over with a feather at the way it turned out and it seems that the people I work with and for are, indeed, conscientious and trying to do what needs to be done to improve their situation and work environment for everyone concerned.

And, once again, I thank you all for your wonderful suggestions and thoughts. It really was incredibly helpful and I am, once again, impressed with the level of care and wisdom this sangha provides across all these miles.

With deep bows,

In Gassho~
*Lynn