“If you’re not part of the solution, you’re part of the problem.” This is a timeworn aphorism in business and in life. It’s sort of related to the saying “Those who can, do. And those who can’t, just get in the way.” (It was actually “teach,” but that’s not my point.) We all know people who just get in the way. Some are actively obstructing; others are just obstacles, passive and oblivious as always. When I first took my new administrative role at Wills, it was very exciting to bring fresh eyes to a venerated institution, and to identify and address people and processes that might need optimizing, educating and engaging. There were wins both big and small. When I arrived, my position didn’t exist, so there was lots of new ground to cover. There were lots of obvious—to me anyway—issues that I could help address quickly. Now, as I approach three years in this job, most of the easy wins are behind me. There’s still a lot to do, as with any large institution. It’s a living thing, always changing. And, of course, the environment we live and work in is always changing, too. So, there’s no lack of fires to put out. But overall, a few of the remaining bigger issues are both long-standing and recalcitrant. I guess if they were easy, they would’ve been addressed long ago. These aren’t just operational issues, but recalcitrant people, too. I guess I should expect to have to struggle at times, as it isn’t always easy; there are long-established behaviors, workflows, expectations, abuses. Again, this isn’t unique to where I work but now it’s in my wheelhouse. I’m occasionally frustrated. It pings my ADHD when an issue needs a longer time horizon to fix. I’m an “on the list, off the list” kind of guy, which is not always a good way to be. Some situations/people require more engagement and more conversation to achieve even small movement. Some seem impossible to fix. But how do you know when you’ve crossed that line? And if they’re impossible, what’s the next step?

Systems and workflows can be easily changed if the people involved want to or are compelled to change them. Some individuals, not so much. Of course, the diversity of personalities is endless. Some are eager and open to changes or suggestions. Some are happy to be involved in the process. Others are resistant, arrogant or angry—maybe all three. I frequently joke that I failed Psych in med school. I didn’t. But I don’t really consider myself the most empathic individual and struggle to understand people who make life difficult. I should be more understanding, given the work I’m now doing, and maybe I am a bit better these days because I have to be. But when, despite your best efforts, individuals are unmoved and obstructionist, what’s your next move? You could say just fire them, which in many cases should be true. But, it’s rarely that easy. Aside from HR issues, you have to consider the impact of dismissing someone, anyone, would have on the organization. Consider the impact it would have on coworkers, work flow and even reputation. From a humanitarian viewpoint, that should be the last resort. But I fear that alas, there is a limit to my personal tolerance for those who not only don’t want to help the organization move forward but are sabotaging your efforts. 

I have to stop feeling like it’s a personal failure when I can’t resolve every intractable situation or every difficult individual. I do have to stop, but I don’t have to stop trying. All the great work being done here, involving so many outstanding people, helping so many patients. At the end of a challenging day, that’s what I have to remember. That’s why I came out of retirement and why I get up every morning. It can be easy to lose your perspective when facing seemingly impossible issues, but that’s just part of life. And I’d rather be part of the solution than walk away from the problem. 

Dr. Blecher is an attending surgeon at Wills Eye Hospital.