This is one of a collection of stories that are like “Final Destination” meets “The Monkey’s Paw” (W. W. Jacobs, 1902). As such, they are tragedies more than either mysteries or horror, and would appeal most to readers who enjoy the inexorable pull of a story arc that leads to doom. In each story, a protagonist makes a wish that comes true with fatal results for someone, often the person making the wish. Nothing supernatural, but just how things work out. (Or is it?) The technical details surrounding the fatal (or near-fatal) event are drawn from real cases in the US OSHA incident report database or similar sources and are therefore entirely realistic, even if seemingly outlandish. The plots draw lightly from cultural beliefs around actions such as pointing at someone with a stick or knife, wishing in front of a mirror, or stepping on a crack.
Dr. Helgaard Johannes Kromhout (PhD) was a serious and studious man whose patience with frivolous or pointless activities was very thin. As the hospital actuary, he measured performance and productivity, and if there was one theme that ruled his life, it was the discovery and reduction of fraud, waste, and abuse. As a result, people avoided talking to him, and he usually ate his lunch at a table all on his own. This suited Helgaard just fine.
An anomaly in the inpatient bed utilization numbers had been puzzling him. He had narrowed the problem down to the cycle time from a bed being flagged in the system as “dirty/unoccupied” to the time it was marked as “clean/available.” He had shadowed a few of the bed cleaning crews with a stopwatch and voice recorder, then watched people at each point in the workflow. It didn’t make sense, though. Using the staffing numbers, the cycle times, and the patient demand rates, he calculated that the bed availability should be overall 28.53% better than the actual figures. It simply didn’t make sense.
Frustrated, he switched to a different problem: floor cleaning. In theory, every floor should be cleaned at least once a day, the ORs after every surgery, and the EDs after every shift. Yet this was not happening. Same-day general floors were only cleaned every day 85.7% of the time, the ORs sometimes were delayed waiting on cleaning, and the EDs often missed a cleaning shift. Here too, the numbers didn’t predict the reality. It was very frustrating.
The CMO was also feeling frustrated. Looking at her staffing numbers and projections of demand, it was clear that clinician staffing was lagging behind patient needs and that the gap was widening every year. With each intake of new residents, the demand inched ahead, and it seemed to her that unless she added more slots, they would never catch up. The CNO was reporting much the same pattern; the number of nursing slots just never seemed to meet demand and the patient/nurse ratio just kept growing. Over the last 10 years, this clinician mismatch with care demand had grown from a matter of curiosity, to a cause of disquiet, to a sense of panic. All members of the leadership team were alarmed, and then when they saw the overall staff growth numbers, they grew impatient and even angry. While clinician headcounts had grown slowly over the decade, the administrative and support staff numbers had simply exploded. For every clinician, there were more and more patients, but also a rapidly expanding horde of clerks, accountants, and roles they hadn’t even heard of before. On top of this, some admin staff were apparently there just to tell the clinical leadership that there weren’t even enough admin staff. The CMO looked over the notes from a meeting this morning with … she squinted at her writing … a Lean Six Sigma Master Black Belt. She stared at the title, and for the life of her, couldn’t make the words make sense. Anyway, he had questions about bed cycles, floor cleaning, security guards, and a whole bunch of things for which she had no answers. So, she made it the CFO’s problem, and sent Dr. Kromhout and his many questions to the finance department, where they had ample staff to answer his questions.
Helgaard left the finance department with numbers. After poring over them for several hours, he stood with his hands behind his back and stared out of his fifth-floor window at the city lights and the traffic flow: long streams of cars, their tail lights little red dots in the distance going into the city. An opposing stream headed out of the city to the suburbs. For a moment, he reflected on how wasteful it was that people came in and out in opposing waves, like there was some balance. Then he held that thought. Balance.
Going back to his desk, he reduced all the staffing numbers to ratios of staff to patients: nurse to patient, physician to patient, clerks, cleaners, guards… Next, he looked at industry averages, and suddenly he saw something interesting. This hospital had a payroll for hundreds of admin staff more than expected based on the industry average, but productivity was as though they were the same. Helgaard thought a moment, and as insight dawned across his face, he whistled slowly at the sheer brazenness of it all.
Andy was one of those people who just seemed invisible. As an HR manager, the clinicians barely noticed him, and other admin staff looked at him as inconsequential. He had heard what others thought of HR in general and often him in particular. In the cafeteria, he had heard cleaning staff refer to HR as “empty suits,” while security had called them “shoe flies” and the maintenance staff said HR had “bullshit jobs.” He had often heard the quality & safety staff suggest that HR could simply be eliminated as “waste,” while the IT and Bioengineering staff had pondered replacing HR with robots. “I mean,” one IT person had asked out loud, “we could automate onboarding, let managers do their own hiring and firing, and who the hell needs annual appraisals anyway?” As far as Andy cared, they could smirk all they liked, because in another year or so, he and two of his buddies in HR would be retiring to Aruba. Then who would be laughing, he wondered, and a sly smile stole across his face. As clever as they all thought they were, they were totally blind to what he, Bob, and Jack had done.
Helgaard had a fair idea, though, and had a spreadsheet that now itemized over 300 ghost workers on the admin payroll, broken down into three categories:
– Temp workers that didn’t exist
– Employees that had never worked at the hospital
– Terminated employees who were still on the payroll
In each case, someone in HR was quite obviously putting through fake employment forms, or intercepting termination forms, and then routing the paychecks to themselves. Looking at the HR and payroll workflow, he guessed there were probably up to three people involved. Helgaard crafted an email with some questions and sent them to the head of HR requesting a meeting the next morning. He smiled, went home, and slept like a Lean Six Sigma Master Black Belt who has just identified a big fat source of waste.
The morning started out gray and overcast with a fine drizzle settling on the roads. Helgaard prepared for his meeting with the HR director, the director added a request to Andy for explanation of the questions in Helgaard’s email, and Andy picked up a breakfast burrito on his way to work. He took a bite while he read his emails at his desk, but dropped it when he saw the questions. He furiously typed a single sentence, forwarded it to Bob and Jack, and left without a word to anyone. Andy paused only to grab his gym bag, or what he called his “bug-out bag,” and headed for the fire escape stairs. The bag contained $150,000 in 20s and 100s, a change of clothing, his passport, and a Spanish phrase book. He reached the stairs walking at a normal, bored office-worker pace, but as soon as the door closed behind him, he took the stairs three at a time.
This was a mistake. The staff shortages that his scheme had caused resulted in less cleaning and maintenance, and a leaky gutter had deposited silt and algae on the steps. Andy’s foot landed on one of these steps, shot out from under him, and he came down on the steps on his back. The impact on his neck and head stunned him for a few moments, and it took him a minute to regain his breath. He limped down the remaining flights. In his car, he checked traffic for the quickest route to the airport, threw his phone in the garbage bin, and got going. He planned to stagger his trip so that he left a difficult trail: first, drive to the airport; take a short flight to a city in the next state, then a bus to the next city, a cab to a rail station, and then a flight, first to Denver, then Calgary, and then a coach to Toronto; and finally to Aruba. The stress was making him a bit nauseous, and he had almost an out of body experience: his fingers tingled and his arms felt weak. His whole face felt like it was sliding off, he was that freaked out. He took a deep breath and pulled over on the highway shoulder. Maybe he just needed to put his head between his knees for a bit to calm down. He opened the car door, swiveled round, and the moment he bent over, he went into convulsions from the bleed in the base of his skull. He was still in that position when the highway patrol checked out the stationary car 2 days later.
His accomplices reacted in a similar way. Grabbing their bug-out bags, they headed to Aruba, where they had bought property and invested the rest of their money. Bob, however, had forgotten he had a gun in his bug-out bag and was picked up by airport security. In an attempt to flee, he was fatally shot. Jack did get to Aruba and was ecstatic when he cleared customs. However, as he was not the greatest at the fine details of plan execution and risk management, he had not ditched his cellphone. When he walked through the gate, security was waiting for him.
Many people benefitted from the affair. The people who wished for HR to be replaced with automation largely got their wish. The scandal cost the VP of HR his job, and it was decided that automation and self-service would be cheaper and more efficient than a large HR department. The recovery and subsequent payroll shakeout released funds for the CMO and CNO to add slots, and IT installed an app that did the birthday notices, ordered cake, and sent cards. Annual reviews were terminated by Dr. Helgaard Kromhout as a complete waste of time that fulfilled no strategic or operational purpose and moreover irritated everyone and took thousands of person-hours a year. As he said in the email announcing it, “If a manager doesn’t know on a daily basis if their direct reports are performing well or not, no annual review will correct it.” The CMO had second thoughts about the usefulness of Lean Six Sigma Master Blackbelts and bought him a nice bottle of whiskey by way of appreciation.
