The other day I went to visit my father in St. Agonistes Hospital about five hours from my home, where I got to witness a clear manifestation of BCD or Bureaucratic Compulsive Disorder, an affliction that compels organizations to do irrational things for their own sake. My dad has unfortunately been at St. Agonistes a lot in the past year, so I am familiar with their Covid protocols for visitors, which apparently have not changed much in the face of changes in our understanding of the virus and its treatment, such as the vaccine.
The rules are pretty basic. Visiting hours are limited to 11am to 6pm, a considerable reduction from the hospital’s former hours of 8am to 8pm. I guess limiting the hours makes it less likely that someone could spread the disease, but I doubt it. After all, if I have Covid, what is the difference between being there seven hours vs twelve? I am no epidemiologist, but I imagine that seven hours is plenty of time to spread an infection.
One other restriction is that you must check in at security when you enter so that they can take your name and information and write it next to the name of the patient you are visiting (and, yes, this is all done on paper). That way, no one else can visit that entire day. I don’t mean that they are trying to prevent two people from visiting the same patient at the same time. That sort of makes sense. I mean that the patient can have no other visitor for the rest of that day. It’s a weird rule. They enforce it by making you wear an address label with your name, the date, the room number, and the security officer’s initials.
When I went to see my dad, I got there a few minutes before 11am, and they crowded the fifteen or so visitors who were waiting into a small atrium, transforming the space into a sort of impromptu Covid rapid infection unit mitigated only by our requisite masks. A little after 11, they had us line up inside the lobby, which was awkward because people had to sort themselves in the order we had arrived since the atrium was too tiny to maintain a line.
Being polite or stupid or both, I just went last even though others had shown up after me. It took a while to process everyone, but it was smooth from there. No one asked about vaccinations or tests, but they did take my temperature. Of course, because of my visit, my brother could not see our dad that entire day. I would be my father’s only allowed visitor for the next 24 hours even if I only stayed a minute.
I relate this anecdote because I am fascinated by the bureaucratic thinking that went into maintaining these protocols. Maybe there is some compelling public health research backing these policies, but nah. The protocols seemed makeshift as though they were hastily established in the early days of the pandemic — when we were still disinfecting our groceries and avoiding our neighbors — and were left in place without reconsideration. Worse still, the hospital did nothing to alleviate or even acknowledge the considerable stress and anxiety that both patients and their visitors will naturally be experiencing in a hospital setting.
Disclaimers
Before I continue, I need to point out that I am no knee-jerk enemy of bureaucracies. I actually believe bureaucracies and bureaucratic functions are a necessary bulwark against arbitrariness except when, as at St. Agonistes, the bureaucratic policies themselves become arbitrary, which is all too often. I have written on this balance in the past.
Nor am I against Covid protocols. I am willing to do whatever keeps people safe. Finally I certainly recognize that, in the context of my father’s hospitalization, this situation was but a peccadillo. I merely document it as a fine instance of bureaucratic inaction.
What gets me about St. Agonistes’ Covid protocols for visitors is that they do not reflect our evolving understanding of the disease and new treatments. This neglect is probably due the fact that by one measure and one measure only, the most important measure, they have worked. The hospital has avoided major outbreaks with these controls in place. But it is an error to readily attribute this success to these overly restrictive visitor protocols, which is precisely what they seem to be doing. Such reasoning, for those keeping score at home, is what we call cum hoc ergo propter hoc (with this, therefore because of this), or cum hoc for short, a fallacious assumption that correlation is the same as causation.
Since the beginning of the pandemic when these policies were put in place, we have learned much more about how the disease spreads and how to prevent it. The arrival of mass vaccination, however imperfect, has been a game changer. Meanwhile, St. Agonistes does not even ask if you have Covid symptoms let alone a vax or recent test. So, I could saunter in sporting full-blown Covid and, so long as I did not have a fever, the only thing preventing me from spreading the virus is my mandatory mask. Take that, acute-care patients!
St. Agonistes’ persistent insistence on limiting the number of visitors throughout the entire day is likely due to what I call Bureaucratic Compulsive Disorder or BCD. BCD is born of the assumption that if an organization has reached a desired outcome, then anything that took place along the way of reaching that outcome must have positively contributed to the achievement and must be perpetuated. Cum hoc ergo propter hoc. The common cry of the BCD afflicted is, and you have heard it many times, “But this is our policy!”
The hospital apparently assumes that because visitors were not spreading Covid, everything they were doing at the time must have been effective and therefore must be continued no matter how apparently unscientific, ineffectual, irksome, disheartening, and even cruel the rules are. It’s like concluding that because you were jauntily whistling the William Tell Overture the first time you went through the automatic door at your local supermarket, you must whistle that same tune every time forevermore to get the doors to work. Cum hoc reasoning, like its cousin post hoc reasoning, can lead to such compulsive behavior.
Perhaps I am all turned around on the effectiveness of St. Agonistes’ Covid protocols for visitors, but I doubt it. Their restrictions seem a great example of BCD inaction. We know that patients tend to do better when they receive visitors and that the quality of medical care increases when loved ones are present. It shouldn’t be that way, but it is.
Worse still, St. Agonistes’ policy is likely counterproductive. We know there are more effective methods for preventing the spread of Covid than just arbitrarily limiting the number of visitors and the length of their visits. Combine that with our knowledge that limiting visitation will potentially lead to less desirable medical outcomes across the board, and you have a case of a hospital not doing its best for its patients.
Again, bureaucracies are not inherently bad and can be highly beneficial and even necessary, but if you work for or with a bureaucracy, be on the lookout for the signs of BCD:
Arbitrary rules and procedures
A callous disregard for unintended consequences
Rampant intransigence
A deep-set reluctance to self-assess
A lack of common sense, and
The dumbass mantra, “But this is our policy.”
If your organization suffers from BCD, it is up to you to call it out and root it out in order to keep our bureaucracies healthy and effective. Make it your policy.
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BCD: Bureaucratic Compulsive Disorder