August 24, 2009

Advice asked: case load too high, what to do?

Today I received a mail from a friend of mine who asked me if I could ask my network for help with a question. Here is his question. If you have any solution-focused advice (or other) for him, please let us know.

Dear fellow consultants and coaches,

I'd like to consult with you on the following case. My question is: What is the best advice to give to these women? Today I met two women who work as psychologists in an institution for people with mental and physic disabilities. They have an enormous caseload. Both of them have 300+ clients in their portfolio. Not all patients need permanent care, but the work is very demanding. There is permanent stress. One woman works here for 3 years (she is currently 27) and the other 10 years (she is currently 34). Both of them choose this career for the love of helping clients, providing care. Slowly, but gradually, the feel trapped in the red tape. All the fun of their jobs is squeezed out of them, because of the endless paperwork, with no end in sight. The problem is not uncommon in healthcare, so quitting their job sounds good, but doesn't help. The stress is taking it toll. Work that isn't finished is done in the weekends. I'm under the impression that they are starting to burn up. Now, I'm no career coach. But these women are in desperate need of help. Would anyone care to share some thoughts?


  1. Best thing I can think of is to use a Time Management Matrix and delegate everything they can.

    Another idea would be to parallelize their client interaction. I have no idea if this is at all possible (from a deontological point of view) and will for sure involve tons of creativity but hey... it costs me nothing to type. :)

    Another idea is to take their workload with the management of the institution. Maybe all they need is another colleague. Maybe this is feasible. There are laws that prevent overworking the employees, they are there for a reason. But then again, this depends on the place where this takes place. In some places, the existence of a law is not a guaranty that the abuses will stop.

  2. Thanks Peter!

    All others: also got some ideas? Let them know!

  3. Hi Coert.

    I sympathize with these colleagues.

    A few observations:
    - the Solution-Focused way: coping questions, the miracle question, exception-finding questions, complimenting, you know the drill
    - your friend says in the quoted text that quitting would not be a solution; I would be curious to know how that is so
    - then there is another way. I noticed that sometimes systems that do not work are allowed to still keep on functioning thanks to the heroic performance of a few individuals. Paradoxically, their work prevents the system from failing and from taking corrective actions. It is a business model that seems to be more and more common - I see it with Cassie, when she does relief work: a 10-hour shift becomes a 12 hour shift because they are understaffed and they deal with that by doing all the paperwork after business hours. So, in a way echoing Peter, another way could be for the effects of the problem to be felt by higher-ups. So, stop working during weekends; keep to standards and guidelines (number of patients that can be seen per day, requirements, and so on).

    Of course they are the only ones that will find the solution, here are just some ideas and I am sure there are many more.

    Convey my sympathies!

  4. Dear Peter and Paolo,

    Thanks for conveying your thoughts. I agree with you both. Ultimately, they know what the best answer is to their situation. The fundamental problem comes down to budget issues (understaffing, backlog, new rules and regulations. etc.). The workload
    is handed down, sugarcoated with promises that their efforts will pay off in the future. This, however, never happens. There is
    always a new urgent problem. And, as Paolo pointed out, these failing systems keep functioning, due to their efforts. I’ll have look into the laws regarding overwork, but that’s certainly something to look into.

    Thanks gentlemen.

  5. Hi All,
    Here is my penny’s worth. Paolo makes some important statements about non-functioning organizations being kept afloat by heroic individuals. I would like to ask these colleagues in detail what they want for their lives, personal and professional. I would also like to know what are their best alternatives to the existing situation, what are they prepared to except as the bottom line. By this I mean something like what is their best alternative to a negotiated agreement (the Harvard BATNA). What are the minimum aspirations that have to be met to still enjoy their work? And I would investigate their priorities. What is really important to them and what should be attended first and what can be ignored if must be. I would also like to know when things are going a little bit better and what they do to make it a little bit better. Are there any weekends that they do not take work home? What did they do during that week that made that happen?

    From personal experience I also know that it is sometimes difficult to distinguish between important and necessary and to choose doing the important above the necessary but not important. To burn out helps nobody. I know, I have been there. Some tough choices lie ahead. What would be the first small step that would really make a difference? What good exceptions from the past can be repeated? This will be a process with no quick fixes.


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