It’s 3am and You’re the only Doctor On Call…
You’ve got a sick patient who you’ve been called to see on a ward you never knew existed, you can’t find the nurse who called you, you can’t find a blood test bottle, you can’t find the right investigation request form and the operator seems to be on strike. Whether you’re a doctor, nurse, manager or hospital executive you’ll have encountered someone who’s been through one of those nights.
So it got me thinking. I spoke to a few people. Doctors, nurses and managers.
We got chatting about what really annoyed us about the wards, clinics and hospitals we worked at. What would we change?
If I had a penny for every gripe we came up with then I would cash those gripes in at the bank right now and officially retire. Alas, instead I am blogging about the aforementioned, yet cathartic process we went through. So let’s look at some of the organisational issues facing your average hospital.
My goodness the total amount of time I have wasted on a solitary night on-call trying to find a needle, syringe or blood bottle, nothing really important obviously, verges on hours. It’s not like I had an ill patient to look after or anything. Some rather clever designer clearly felt that every ward should have its storeroom cupboards arranged differently and subsequent managers felt it was best to layout all the LIFE PRESERVING equipment in completely obscure places. I haven’t even got to the evening I spent an hour searching for a mythical endoscope…
Patients with chest problems quite often need chest x-rays. When patients have advanced chest conditions they require chest CT scans. When patients have abdominal pain they quite often need abdominal CT scans.
So. The genius who thought the CT scanner should be located on the equal and opposite end of the hospital must be a real sadist…
But we have porters I hear you cry! Alas, it often seems to be a portering system supplemented by untrained junior doctors and nurses. No matter, it’s not like the patients’ care is being delayed in any way shape or form. Its not that the patient needs to be transferred to Intensive Care or really needs to be taken for dialysis (located somewhere in Narnia).
“You are being put through to Mr James Holliday.”
“Sorry I did not catch that, please repeat your request.”
“You are being put through to Neuroradiology.”
And that’s a human operator…
Whether its’ filling in or finding paperwork it’s all infuriating. From the patients’ folders that seem to have an uncanny ability to spill their contents everywhere or their ability to lose the all important test results or the request forms that always seem to be elusive at the best of times.
Paperwork. Man’s worst enemy since AD 105.
Now that list was by no means exhaustive but it gives you a flavour of the types of issues that really aggravate healthcare professionals on the front line. I haven’t even got to the patient referral systems but I digress. What’s the answer?
Well, the good news? It’s all a matter of thoughtful re-organisation. A collective feng shui.
The bad news? It’s going to require some cash money.
The reason I transitioned from practicing physician to healthcare consultant was because many of the problems facing healthcare can’t be summarised on a spreadsheet or in a pie chart. They are experiential, frontline experiences. They can be fixed but it requires a collaborative effort on all sides to sit together and brainstorm the solutions (some prefer painstorming).
Since we can’t go around tearing down hospitals and rebuilding them there are limitations on what we can do but we can still make marked improvements. What’s exciting though is that there is significant global investment occurring in healthcare especially in the Middle East, Asia and Latin America and it’s in those locations where we can cultivate effective healthcare systems from the get go.
A little bit of talk might save us all a lot of time.