Ever heard of matryoshka dolls? A set of identically painted wooden dolls of decreasing size placed one inside another? They are the perfect metaphor for a hospital – for integrated capacity management to be precise.
During the 1900 world fair, Mrs Mamadova received a bronze medal for her matryoshka dolls, the new rage in playthings. The innermost doll is turned from a single piece of wood; the rest of the set are completely identical, except that they are hollow and fit together like the layers of an onion. The outermost doll protects all the smaller dolls inside it. In addition, all the dolls are painted exactly the same to show that each one of them is part of the larger whole. Because one such doll on its own just doesn’t do the trick: the cheerleader effect.
One sunny Sunday afternoon I found myself walking round Fountain Square in Baku, where an older woman had some matryoshkas on display. She gave each doll a quick, loving glance before placing it inside the next size. When she realized I was watching, she explained that these dolls symbolize a human being. The innermost doll is the soul, and each subsequent doll symbolizes the growth and life experience that protects the soul. The outermost doll is therefore not the person itself but its ‘user interface’.
She then told me that any damage to a doll, even a tiny scratch, ruins the whole: they don’t fit together as well, they damage each other, and their mutual connection is gone. Just like with people. And as I walked away, she called out: və ya hökumət. ‘Or a government’.
Və ya hökumət
Ten minutes later, I received a call about the difficult situation in a Dutch hospital following a drop in production. My enthusiastic response that an empty hospital was the ultimate goal of every doctor – make cancer history! – went down badly. After some half-hearted attempts at giving advice, the telephone conversion was quickly broken off.
This coincidence on a sunny Sunday afternoon in Baku got me thinking differently. Look at hospitals like matryoshka dolls: the innermost doll is the primary process, surrounded by utilities, administration, planning, control, registration, rules, protocol (JCI), nursing, advisers, and so on.
A drop in production has a direct impact on the soul of the hospital, the innermost doll, and therefore the other dolls: the surrounding activities. Just like the lady told me: everything falls apart.
The past years I’ve worked with pathways of care, lean processes, modern sociotechnology, or relational coordination in order to optimize the quality/cost ratio. And on that Sunday afternoon at Fountain Square, I realized that I was perfecting only one doll and optimizing only one chain – and even making the connections complete. Up to then, never had I realized that instead of linking together the chain – the two-dimensional elements – I should be fitting together the dolls – the three-dimensional elements – if I wanted to make the organization function better.
Now we develop matryoshka management and control systems for Dutch hospitals. Elsewhere our services go by the trendy name of ‘integrated capacity management’, but I’m sticking with my old Azeri lady with her loving attention to her dolls as a model.