Bureaucracy: Resistance to Change and Adaptation

By Janis Prince Inniss

In previous posts, I’ve discussed some of my terrifying and then reaffirming experiences related to my mother’s hospitalizations. With hospitals stays behind her, once Mum began daily radiation therapy and chemotherapy treatments transportation became a new challenge for her. She was recovering from major surgeries and receiving treatments that while ultimately expected to be beneficial, are rather punishing. She would need transportation. Turns out that having cancer qualified her for Tampa’s HARTplus door-to-door bus service for people with disabilities. We were thrilled that she would be picked up at home and taken to her appointments, but that elation did not last for long as the dysfunctions of the bureaucracy soon rivaled the gratitude I felt for this service. 

According to Google Maps, the trip from Mum’s home to the location of her appointments is 13.3 miles and takes 22 minutes. Indeed, that’s about the time it takes me when I can take her. But with HARTplus, all bets are off! Once it took her three hours on their van to get home. Hungry and thirsty, but abiding by the HartPlus rules, she ate or drank nothing for the entire time; due to her surgeries and treatments she eats small meals so this was particularly punishing and added to her fatigue. 

Every day for one week drivers were to pick her up at a treatment center on a hospital campus, but they routinely went to the main hospital entrance. This kept happening although at the time of booking Mum gave the street address and the name—clearly visible outside—of the building where she would be. A few times the drivers left her saying that she was not there! Not only did this leave her stranded, but it counted as a no show, essentially a demerit that could ultimately cause her to be expelled from the service. 

Add to this a rather peculiar scheduling system for which she must book transportation for an hour prior to an appointment, but must be ready half an hour earlier than that; in other words, she has to be ready to leave an hour and a half before any appointment but may have to sit and wait an hour for the van to arrive. As inconvenient as that might be, I thought that meant she would always be on time. Wrong. She has missed several appointments because she arrived late! 

Another challenge has been rescheduling the time that she would be picked-up when a procedure took longer than expected. Recently when a nurse called HARTPlus to say that she would not be ready at her scheduled time, the nurse was told that she had to call one hour before the scheduled pick up time—as opposed to the longer notice she was trying to give them! The nurse got busy, called with less than an hour before the appointed time so the van went to pick her up. Mum was not ready so she was deemed a no show and received a demerit! 

There is more. HARTplus does not allow passengers to book their return trips less than an hour and a half after their appointments. So although the longest her appointment lasts is 15 minutes when she goes for a sometimes daily shot to boost her white blood cells, Mum cannot hope to wait less than an hour for a return ride! She has to assume that she’ll spend about four hours each day—most of it waiting for her van—to get one shot. Her description of one recent trip is unfortunately not unusual:

I was picked me up at 4:40 for a 4:00 o'clock pick-up. We were zipping along nicely on (the appropriate freeway); the heavy rush-hour traffic was in the opposite direction.  The driver left the freeway two exits before mine, got on another freeway for a short while and then got off near downtown into the afternoon traffic and long lines at the traffic lights. We then went on a toll road that put us into downtown at rush hour! Because of this circuitous route, without picking up or dropping off anyone else, I got home at 5:45.

Sociologist Robert Merton’s work can help us make sense of this. Merton pointed out that bureaucrats are rule-bound. They are trained to depend on policies. Common-sense and flexibility are anathema to bureaucrats. There is no reward for creativity in bureaucracies either. The reasons and benefits of having rules are many, and I assume that there are good reasons for the HARTplus rules; however, they do not fit the needs of cancer patients. When HARTplus decided to include cancer patients in their system, mid to high level bureaucrats should have considered how their system would need to be adapted to serve this new clientele. They should have learned some basics about the needs of cancer patients and trained their drivers about the pertinent issues. 

Regardless of the disability, but certainly because of the side-effects that chemotherapy produces (nausea, vomiting, and fatigue to name a few) a priority would be the prompt transportation of these clients. In fact, what Merton called bureaucratic ritualism—holding on to rules even when they prevent the stated goals—seems to be operating given that these services do not exemplify the company’s stated mission to be “safe, dependable, and cost effective”. Merton recognized that a major weakness of bureaucracies is that they have trouble serving our needs; perhaps given the requirement for change and adaptability in transporting this population, it is not surprising that bureaucracy can render the service ineffective.

Comments

[Maddy Brownlee]

I was delighted to stumble upon this long over-due article bemoaning the problematic nature of bureaucracy. The problems within the bureaucratic structure are particularly evident in interactions between the clerks, guards and other employees of a bureaucracy and the members of the groups they so frequently mistreat. This marginalized group includes: foreigners who speak little or no English, the elderly who may become easily disoriented, the physically disabled, and all others who are effectively left to fend for themselves in a system where speed, is valued above accuracy.
I find this lack of empathy for the people who deserve humane treatment to be appalling. Over the years, while waiting in various bureaucratic institutions, I have frequently observed a member of the afore mentioned group being blatantly mistreated by an employee of a bureaucracy. Upon witnessing this unfair treatment of others, I have frequently intervened. In these situations, I have found that when I patiently answer someone’s question which has been repeatedly ignored, or when I translate what a clerk is saying into French for a confused tourist, the gratitude I receive for simply treating someone like a human being is overwhelming.
Each time, I wonder, is it really so difficult to take the few extra seconds, to hold the door for a girl on crutches, to repeat a phrase to a grandfather with a hearing aid, or to let the exhausted pregnant lady go before you in line? I am an optimist, and I believe that every person has the potential for kindness towards others, but each time I witness such an event, I am struck by the complete disrespect for others usually explained as the byproduct of a flawed system.
When attempting to understand the inner-workings of such institutions, I find Merton’s theories on bureaucracy quite helpful. I applaud the author of this article for his/her decision to cite Merton’s idea of bureaucratic ritualism (“…holding on to rules even when they prevent the stated goals”) as the culprit responsible for such a maddeningly inefficient system.
It seems necessary to inquire whether it would be possible /worthwhile to rectify such a flawed system, or whether it would be more appropriate to move towards a more flexible and effective system? Also, would moving away from the rigid hierarchy associated with bureaucracy allow for communication to flow freely, and ideas to be exchanged between all employees regardless of job-title? I am intrigued by the mention of Japanese companies taking a new approach to the problematic aspects of bureaucracy.

[Maddy Brownlee]

I was delighted to stumble upon this long over-due article bemoaning the problematic nature of bureaucracy. The problems within the bureaucratic structure are particularly evident in interactions between the clerks, guards and other employees of a bureaucracy and the members of the groups they so frequently mistreat. This marginalized group includes: foreigners who speak little or no English, the elderly who may become easily disoriented, the physically disabled, and all others who are effectively left to fend for themselves in a system where speed, is valued above accuracy.

I find this lack of empathy for the people who deserve humane treatment to be appalling. Over the years, while waiting in various bureaucratic institutions, I have frequently observed a member of the afore mentioned group being blatantly mistreated by an employee of a bureaucracy. Upon witnessing this unfair treatment of others, I have frequently intervened. In these situations, I have found that when I patiently answer someone’s question which has been repeatedly ignored, or when I translate what a clerk is saying into French for a confused tourist, the gratitude I receive for simply treating someone like a human being is overwhelming.

Each time, I wonder, is it really so difficult to take the few extra seconds, to hold the door for a girl on crutches, to repeat a phrase to a grandfather with a hearing aid, or to let the exhausted pregnant lady go before you in line? I am an optimist, and I believe that every person has the potential for kindness towards others, but each time I witness such an event, I am struck by the complete disrespect for others usually explained as the byproduct of a flawed system.

When attempting to understand the inner-workings of such institutions, I find Merton’s theories on bureaucracy quite helpful. I applaud the author of this article for his/her decision to cite Merton’s idea of bureaucratic ritualism (“…holding on to rules even when they prevent the stated goals”) as the culprit responsible for such a maddeningly inefficient system.

It seems necessary to inquire whether it would be possible /worthwhile to rectify such a flawed system, or whether it would be more appropriate to move towards a more flexible and effective system? Also, would moving away from the rigid hierarchy associated with bureaucracy allow for communication to flow freely, and ideas to be exchanged between all employees regardless of job-title? I am intrigued by the mention of Japanese companies taking a new approach to the problematic aspects of bureaucracy.

[Matt K]

The question is, what is the alternative? Bureaucracies exist because huge and complex organizations often can't run as well without them. Do we want a clientelist system instead?

I know people get frustrated but it seems strange to suggest that we dispose of bureaucracy when it really is necessary to our highly organization-based society.

[Jacqui]

People do have a hard time with change, and I understand that change can take some times, but this is ridiculous. No one should ever be treated that way, and no one should be allowed to run their program like that. A service is when you serve other people, not put yourself first and treat patients or clients like they're a thorn in your side. That's your job! You must treat everyone with respect.

[John]

Why didn't you just drive your mother if you care about her so much