organizational culture is toxic

I know! Months between posts, and then two in one week.

This isn’t a new thought, but it’s one that keeps coming to me, and I’m curious to hear what you think:

Organizational culture is toxic.

It fosters us-vs-them thinking. The loyalty it creates among members makes it hard to, for instance, speak out against bullying or abuse. But it can also turn the world outside the organization into an enemy.

This is true for any scale of organization, from the family to the nation-state. But it is particularly damaging when the organization in question exists to serve the community or ‘other’ it’s standing in opposition to.

Police forces are the most obvious examples: police culture encourages an us-vs-them mentality in which police officers bond together against outsiders, even though the ‘outsiders’ are the reason they have their jobs in the first place. And you end up with the ‘thin blue line,’ and police brutality against ‘outsider’ (read: client) populations considered dangerous due to bias and bigotry.

But the same dynamic is in play elsewhere. I’ve never worked for a government agency, for instance, where some version of us-vs-them organizational culture isn’t in play and doesn’t lead decision-makers and leaders to treat the communities they exist to serve as trouble-makers they need to subdue somehow. In the city I work for, this has most recently and most publicly manifested in city councilors verbally attacking “citizen activists” who delegate to council. When delegating to council is their right, is a part of active citizenship and democracy, and they represent the communities that council exists to serve. It’s not just council, of course. I’ve heard managers say the same: “so-and-so is an activist,” as if being an activist who cares about your community is a crime.

As destructive as this is, it’s obviously much worse from the police, because officers are delegated to use deadly force and have wide latitude in how to apply that authority. Citizen delegates are criticized and humiliated, but not shot.

It struck me today that organizational culture can be deadly in medical organizations too, though, particularly for disabled and chronically ill people. They can’t shoot you, but they can withhold and deny treatments, prescriptions, appointments, etc. Government policies and regulations sometimes require them to do so. This puts medically vulnerable people in needing to stay on the good side of the very people who have often done them the most harm.

One example: until the beginning of the pandemic, I’d used an insulin pump for years. It worked well fifteen years ago, but my blood sugar control had been terrible for years. I’d often end up crying during appointments because nothing would work. I tested frequently, I diligently used correction boluses, etc. But my blood sugar meter wouldn’t reliably connect with my computer so I could only access my numbers during brief doctor’s visits, and it takes time to make changes to pump settings–time that I don’t have, as a caregiver of a disabled kid, and as someone whose insulin sensitivity fluctuates frequently. What works one week often doesn’t work the next.

Provincial regulations require that anyone using an insulin pump see a specialized endocrinologist’s office every three months at least. Pumps are expensive, and private insurers no longer cover them here because of the government program. So: for years, I was required by law to take half a day off every three months to drive to a doctor’s office 45 minutes away where they had no information that could help me and did everything they could to discourage me from going off the pump.

During the pandemic I insisted. My blood sugars are now normal–or close to it–for the first time in over ten years. And now I have the freedom to go to any doctor I want. I don’t know what kind of long-term damage I’ll have sustained from a decade of bad blood sugar control, but I felt both completely powerless and also dependent on the people who were insisting I continue using pump therapy.

They’re not evil. They just have an organizational culture that seems pumps as always and inherently superior and any patient who sees otherwise is a trouble-maker.

Another example: After waiting since August to get some questions answered about Echo’s post-surgery care, I threw a (very temperate) fit when the pre-op was delayed (again, to three days before the first surgery) and asked in strong terms to be referred to someone who could answer at least a few of our questions so we could make even some temporary financial plans.

I was told a social worker from the hospital would call, and one did.

And she was rude, condescending, and basically acted as if being a caregiver in need of information was shameful.

In essence she acted as if her job was not to assist the patient (Echo) or the patient’s support system (me), but was to protect the hospital against foreign influences. I wasn’t the reason that she has a job, you know; the population her role is meant to serve. I was an inconvenience getting in the way of their internal processes. Organizational culture at work yet again.

It doesn’t have to be this way, and it isn’t always. Echo has some superstar doctors and physiotherapists, and we treat them like gold because we know just exactly how precious that is. And I’ve somehow managed to survive working for several government agencies at different levels over 25 years while keeping intact my belief that my salary comes from serving the communities and protecting their environment (which has at times gotten me in trouble with my managers).

I got pretty mad at this lady. Not to the point of swearing and yelling, though I wanted to. I just hung up on her.

Imagine; I’ve waited over three months to have this conversation with someone who can provide some information on what kinds of support might be available in our situation, and I got, “well if it’s going to be THAT hard maybe you should postpone the surgery!”

You are dependent on people for the things you need to survive; required, by government policy and regulation, to be dependent on specific people who can choose to withhold what you need to live. It’s like being required to rent your housing from the police. You better be nice to them. Don’t complain too much about the heat or the windows or the leaky roof. Don’t demand repairs. Pay up promptly and with a smile every time and tell them how much you like their sweater. Don’t complain when the rent changes every month, or the rent due date, or the square footage on your apartment, because they’ll kick you out or shoot you and you will have no recourse. If they want to put the shower in the master bedroom closet, smile and have a productive conversation about where you would rather have the shower go, and be prepared to shampoo your hair surrounded by your dress pants because they don’t have to listen to you.

If you do make a demand, and they get mad, you’d better swallow what you’re thinking until after they’ve made some attempt at a repair. Because they can kick you out and there’s nothing you can do about it, and you’d rather have a shower in the closet than nowhere to live.

It’s less than a week until the surgery date (caveat: so long as the hospitals aren’t shut down again) and we have no information about the recovery. My attempt to get some answers was met basically with a flamethrower. And I’d better swallow it and be ok, because if she makes good on her quasi-threat to postpone the surgery “since this is going to be so hard for you,” it’s my kid who’s going to suffer for god knows how long with terrible pain that is worsening all the time. Or even if they’re just obnoxious to them in the hospital.

But it all comes back to the same problem: organizations developing a culture that stands them in opposition to the community they were created to serve, where the identity of belonging creates barriers to fulfilling a mandate, where clients and communities are re-cast as ‘outsiders’ and ‘trouble-makers,’ and leaving those communities with their needs going unmet by the very people paid to meet them.