The Troubleshooter: Conspicuous If Absent

March 22, 2021
Eric Postal, MD

Identifying someone to pinpoint and fix problems could result in a more smoothly run organization.

I’ve touched on the concept of a troubleshooter in this column, years gone by: A designated member of a team who makes it his business to identify, collect, analyze, and fix problems – sometimes even prevent them.

To date, I don’t think I’ve encountered one, nor recognized evidence of their existence, by the work they’ve done. That’s kind of the point of the role: If there is an effective troubleshooter (or more than one, for particularly proactive outfits), someone outside of the organization probably wouldn’t know.

I’ve seen evidence of the absence of troubleshooters, however. You have, too, even if you didn’t recognize it at the time. Such evidence commonly takes the form of fundamental flaws in goods, services, protocols, you name it. The sorts of thing that should have been noticed and corrected before they ever saw implementation. Or, if allowed out the door, targeted for correction as soon as the first user took the trouble to complain. You might have been motivated to exclaim aloud to someone (or yourself), “How can they function like this?” Or, “How can they continue to screw this up after all the times I’ve told them about it?”

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Some examples, off the top of my head:

  • Websites with “contact us” links that are seemingly not monitored. Send them whatever messages you like, nobody ever replies. Some organizations can’t even manage it internally: Email other members of your team or another subsection, leave them voicemails…it’s like pulling teeth to get a response.
  • Sites with search-functions that never return results. I recall, back when I was looking for a new job, I’d see sites that had telerad gigs amongst their offerings. To screen out the onsite jobs of no interest to me, I’d put “teleradiology” in their search-bar. Response: “No results matched your search.”
  • Various organizations that can’t handle requested changes to contact information. I have a handful of entities that just cannot figure out how to stop calling my cellphone, even though I have told them a gazillion times that I have zero signal at my house. “Just delete the number from your database,” I’ve pleaded/demanded to people who “yes” me to death but, then, do nothing effective. Ultimately, I just changed the “greeting” message on my cellphone’s voicemail to politely tell such callers that they are idiots who can’t follow directions.

And healthcare/radiology are no exceptions:

  • Rad groups whose techs and/or other behind-the-scenes workers routinely populate worklists with studies that have known priors for comparison—indeed, the “reason for study” specifically states that this is to follow the CT or US of date X—and the prior studies are conspicuously absent.
  • Facilities which take no corrective action when their sonographers repeatedly upload images without “worksheets” documenting their findings (or specifically stating that they had no real-time impressions of pathology).
  • Studies somehow making it through the pipeline to reach rads without a single word of clinical history: Forget about doing a decent diagnostic job for the patient and/or referrer, the coders/billers aren’t going to allow those reports to go through.

It’s not surprising that so many of these things go uncorrected. The way things usually are, each little segment of an organization is in charge of its own issues. They’ve all got limited resources and are often overtaxed with other things that, rightly or wrongly, have been given greater priority. Their only consequence for letting this stuff slide is having to deal with more of the same complaints (nagging, perhaps, to their ears)…but eventually the complainers will give up and go away.

The problem with this approach is that customers, and even other members of the team, rapidly get the impression that the organization is sloppy, uncaring, frustrating to deal with, and/or incompetent. And, if it’s incompetent with the little things, can one really have faith that it will be any better with the big issues? Is this a good organization to do business with or work for? Maybe the competition on the other side of town has their act a little more together…

My solution of an appointed Troubleshooter gives these assorted hiccups another path to resolution, one that doesn’t rely on multiple separate sections of the organization policing themselves. Sort of like an internal Grand Inquisitor, the Troubleshooter is known as the person (or team) you go to if you’ve got an issue that just isn’t being resolved. Having taken on a case, the Troubleshooter has authority to demand answers from pretty much anybody, in the name of optimization.

The Troubleshooter collects relevant information from everyone involved: The complainant, whoever the complainant is having issues with, other parties as needed. “We’re working on it” or “We’ll try to do better” are not magical, don’t-bother-us-anymore responses; the Troubleshooter has authority to require a detailed explanation as to how/why the problem hasn’t been solved already. In writing, if necessary.

Having gotten all of the details, the Troubleshooter can, then, analyze the situation and determine:

  • Whether there is, indeed, a problem that needs solving. If not, the complainant gets an explanation and options for dealing with the situation. After all, there’s a chance that he perceived a problem where there really wasn’t one, or that it would be more efficient for him to modify his approach than to require others to change what works for everyone else.
  • The simplest, most effective means of solving whatever problems are confirmed to be present. Maybe another option or two to offer to Leadership, so they have a choice.

The Troubleshooter then conducts a follow-up or two with the relevant parties to see how the solution panned out, and determine whether further action is needed/warranted.

A beneficial side-effect: Folks in various segments of the organization would probably rather conduct their own affairs than have someone like the Troubleshooter, however capable they might be, getting involved. Anointing and empowering a Troubleshooter might just inspire them to self-police a little more effectively.

Follow Editorial Board member Eric Postal, M.D., on Twitter, @EricPostal_MD.