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Nurse White and the Seven Requisition Forms

Gienna Shaw, for HealthLeaders Media, September 30, 2009

The family had gathered at the hospital to say goodbye to the grandmother, who was dying. It was a hot day and despite the somber mood of the adults, the children were getting a little rambunctious in the waiting room. A nurse who worked in a nearby unit was at the end of his shift and heading out the door when he walked by the room where the family was gathered and got an idea. He went downstairs to food services and brought back a brown paper bag filled with ice cream sandwiches. The children were quiet and calm—for a while at least—and it made a difficult day just a little bit easier for that patient's family.

The next day the HR director called the nurse into her office.

"I heard that you gave away ice cream sandwiches to some young visitors to our hospital," she said.

"That's true," the nurse said.

"Is that something we taught you to do in orientation?" the HR director asked.

The nurse shrugged. "Not really. It just seemed like the right thing to do."

"Did you fill out a requisition form for the ice cream sandwiches?"

"A what?"

"A requisition form. Page 55 of your employee handbook outlines of all the forms that employees must fill out in various circumstances. The requisition form is very close to the top of that list."

"I didn't realize that I needed to fill out a requisition form."

"I guess that's OK," she said. "As long as you filled out a supervisor approval form. And a petty cash request, of course. You did fill out a petty cash request, didn't you?"

The nurse just shook his head.

"Let me get this straight. Nobody told you to give out the ice cream. You didn't get permission to do so from your supervisor. And you didn't fill out any paperwork?"

"That just about covers it."

"Well, that's not the way we do things around here," the HR director said. "Can you imagine if we just gave away free ice cream sandwiches whenever we felt like it? Without following any kind of process? With no regard to the cost? Or the paperwork? What do you think would happen if we did that?"

The End (Not Really)
As you've guessed by now, this story is fiction. For one thing, everybody knows that no HR director in the world would call a nurse into her office to reprimand him for giving away ice cream sandwiches to the children of a grieving family.

She'd have one of her underlings do it.

In fact, this story is based on a true story told to me recently, although thankfully the employee was celebrated—not chastised—for making such an incredibly generous and thoughtful gesture.

But chances are someone in your hospital is, at this moment, saying a variation of "that's not the way we do it," "we can't," "we don't," "the problem with that is," "we don't have time for that kind of thing," or "if we did that for one person, we'd have to do it for everyone."

Which character in this story is fictional at your hospital? And how do you rewrite the way things have always been done?

Editor's Note: Make sure to follow Marianne Aiello and Gienna Shaw as they tweet and blog from the Society for Healthcare Strategy and Market Development conference in Orlando, FL, this week. Follow us on Twitter at www.twitter.com/gienna and check out the MarketShare blog for photos and updates as well.


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