Comments

I suggest one of the issues at work here is a cultural one about who ‘owns’ the hospital bed. For too long the hospital has seen itself as not only the ‘owner of the bed’ but also the ‘owner’ of all that goes on around the bed and inside the bed. The visitor/carer is too often seen as an outsider at best and an ‘intruder’ at worst to hospital policies written by managers who are far removed from the reality of the front line. Until we achieve a genuine partnership between patient/family/professional, then the type of horror stories Tom points us toward will sadly continue. The best hospitals – and there are many of them - see family members and visitors as PART of the team and not an outsider who is an intrusion. Of course relatives are going to pick up these things because they LOVE the person in the hospital bed and they will be looking for and notice these things. They notice the tiniest and most subtle change that professionals - with the best will in the world - may conceivably miss. As visitors to the hospital we only have one Mom or one Dad in that bed while nurses have to look after 20 – probably more - different individuals in their hospital ward. Please don’t misunderstand – I’m not, for even one nanosecond, condoning missing obvious stuff!

I have never understood why there is not a partnership where we recognise the strengths of each component part of the team – i.e. patient/family/professional …but then... That’s far too simplistic.

Healthcare providers like Planetree (that Tom has ranted about quite rightly for the last few years) have this already cracked … so why don’t the rest?

Posted by Trevor Gay at October 30, 2008 4:09 PM

If hospitals were as safe as airlines and
still treated people like cattle (like the airlines do), what would there to complain about?

Suppose accidental deaths in hospitals were
investigated as thoughly as airplane crashes were. Wouldn't that be a good use of government? Would there even be an airline industry if there was no FAA?
Airlines are safer than they were 20 years ago even if flying itself is a worse experience. Maybe we need an FAA for hospitals.

Posted by zed at October 30, 2008 6:39 PM

You make a fabulous point Zed. In fact the UK National Health Service (NHS) is trying to learn from the airline industry about how to learn from mistakes – it’s just taking a hell of a long time to change the culture from ‘blame’ to ‘learning’. In the meantime it’s down to individual actions by the professionals.

I did some work a couple of years ago on a major government report called ‘Better Doctors, Safer Patients’ written by the most senior doctor in the UK – the Government's Chief Medical Officer, Sir Liam Donaldson.

This particular paragraph from Sir Liam startled me …. And I’m a 35 years NHS veteran – it still bothers me a lot;

“Once doctors reach ‘independence’ status – i.e. consultant level – their knowledge, competence, clinical skills or performance are not formally assessed from that point until they retire. That could be 30 years. Contrast that with pilots who are formally assessed up to 100 times in that same time period.”

Remember this was written the BOSS DOCTOR OF ALL UK DOCTORS – not by some unqualified person with an axe to grind about doctors - Is that scary or what?

Posted by Trevor Gay at October 30, 2008 7:00 PM

Unfortunately Tom the problem with health care is not specific to only America. Here in Australia we are shamed by the fact that a young girl in her mid twenties was refused THREE time a request for a pap smear. She begged the hospital to carry one out but they flat refused her.
Well...she has been diagnosed with advanced ovarian cancer and has now been forced to move her wedding day forward so she can do it before she dies.
How can these people sleep at night?

Posted by simon at October 30, 2008 7:58 PM

Are you sure that pap smear story is true?
there is a story like that about a girl from cincinatti (usa) that is exactly the same right down to the number of pap smears.

Posted by zed at October 30, 2008 8:30 PM

To preface my comments - I work in healthcare research and have several nurses and doctors in my family tree.
A few years ago, my father had a stroke and was in the hospital (but he was not there for the stroke - rather for pneumonia after the nursing home laid him flat on his back and he aspirated liquid). My sister in law (a nurse) gave me some striking advice based on a similar experience with her elderly father. She told me to fill the room with pictures, cards, and expressions of love and care to show the hospital workers that he is valued. The subtle psychological aspect here is simple human nature - better care for a more highly valued person. So - I did that. But I still had to ask for balm for his parched, cracked lips.
Remember - I have wonderful caregivers in my family and work with great clinicians, so I am not grinding an axe. There are workers who care MORE for the under-loved and under-served. But -if I'm in the hospital - please send me lots of flowers and cards and teddy bears.

Posted by Margaret at October 31, 2008 5:40 AM

Margaret - You make a great point thank you! I just adore your statement; "The subtle psychological aspect here is simple human nature - better care for a more highly valued person." Amen to that - and dare I say 'Simplicity' strikes yet again. Just one thought Margaret. My only concern is - would the jobsworth bureaucrats allow me, as a patient, to enjoy my flowers, cards and teddy bears in my hospital room or would they insist on detailed risk assessments through complex systems just in case of infection risk? .. In which case I would probably die whilst waiting for the results of the risk assessment before I had the chance to enjoy my Teddy Bear …. Just joking ... I hope!!! :-)

Posted by Trevor Gay at October 31, 2008 6:56 AM

Just to put some perspective into the, "All hospitals except a few are rubbish" theme. They're not all rubbish.

My Dad died a few days ago in Milton Keynes hospital, UK. They were fantastic. Clean and tidy hospital, handwashing facilities at the entrance to the wards, polite and helpful staff everywhere.

I suspect my impression has got nothing to do with vapid generalisations about front liners, bureaucrats, clinicians etc. I got the distinct impression there's a management team that's pulling everything together and fostering a great atmosphere. Why is it that when things go wrong its Management's fault and when things go right it's to someone else's credit?

BTW Trevor - the NHS now has a 16 page form about how to manage a patient's death. I read it and laughed. As well-intentioned as it may be, it's the ultimate "If you have to have this written down for you, you've no right to be in healthcare" document.

Posted by Mark JF at October 31, 2008 7:57 AM

First of all Mark the important stuff – my sincere condolences to you on the death of your Dad – I lost my Dad 14 years ago and I still miss him every day. Dads are special. Ironically I’ve done two fairly big pieces of work for Milton Keynes Primary Care Trust in the last 9 months and I would endorse your opinions about them from my own observations. I know the management team are fully committed to improving the patient experience.

Like you I don’t sign up to the “all hospitals are rubbish expect a few.”

You will see I said in my first comment in this thread “The best hospitals – and there are MANY of them - see family members and visitors as PART of the team and not an outsider who is an intrusion”.

I will always support and praise healthcare managers in hospitals when things go well. Where things do go well in healthcare it is almost always through effective team working in my experience where managers know their place as full members of the team. So everyone gets praised. Managers rightly get criticised in my opinion where team working is ineffective or non- existent because that is where a lot healthcare falls down and it is management/leadership that is responsible for making team working part of the culture of the organisation. The 'criticism cap' then fits management as far as I can see.

A 16 page form about how to manage a patients death surprises me in only one way Mark – and that is that it is so short if designed by some of the types of manager I know and love (not) in the NHS. I agree entirely with your sentiments on that – I imagine the document has more to do with protection of backs and complying with policy than anything whatsoever to do with improving the patient experience.

Once again please accept my sympathies on your loss.

Posted by Trevor Gay at October 31, 2008 8:51 AM

The cracks in the hospital care system reflect another institutional structure that is failing to adapt to accelerated change. For 30 or so years, alternative therapies have been the choice for many whom the allopathic system just didn't work for. Thankfully, once people get over their lack of belief in science, energy and healing, the gap is starting to close. Integrative medicine is picking up in mainstream which allows the more intuitive health care workers a way to work without self-sacrificing themselves in what is a very abusive working environment (oK, generalization I know). My own mom just passed away and thankfully the ward she was in was fantatstic so I am grateful to all there. At the same time I have had to release my frustration with banging my head against what feels like the allopathic morphic field and the tendency to use pharmaceutical solutions when a more natural approach would do more for healing with less damage, pills, and side-effects. In Canada, CRISH, the Canadian Research Institute for Spirituality and Healing is hosting a conference next spring. We are in the middle of a shift. Happy Day!

Posted by Dawna Jones at October 31, 2008 1:22 PM

I just don't know where to begin.......

I almost got a blood sugar on the wrong patient once, I have had an IV infiltrate, I put the wrong concentration of a morphine syringe in a PCA pump once (the Nurse before me changed the concentration and never told me). I pulled it out it had the patients name on it and it was 10 times the previous concentration. (this case no adverse outcomes and the necessary procedure changes were made)
Dawna you wrote
a way to work without self-sacrificing themselves in what is a very abusive working environment (oK, generalization I know).
this is not a generalization but a all to common reality which goes unaddressed.

I just got this update from my nurse manager, please read and note. Why doesn't the anesthesiologist write his own orders. Isn't this an opportunity for mistakes.

When receiving patients from OR that are already on drips, please remember to write the orders and scan to pharmacy. These orders should be written as verbal orders from Anesthesia delivering the patient and should also include parameters and/or current dose (ie: Dobutamine 500mg in 250 D5W at 5 mcg/kg/min or Levophed 4mg in 250 D5W to maintain MAP greater than 65).

The above orders are a good example of the level of responsiblity placed in the hands of a Nurse. This responsibility comes with no professional treatment. A 'person' came around 10/30 with a bag of chocolate asking what the patient identifiers were. I stated the wrist band and the bardcode. Wrong answer wrist band and date of birth. I was not given the chocolate.

What seems so obviously obsurd is common place every day. The Nurse is ultimately accountable for everything. I have 3 other examples of the above but don't wish to belabor the blog site.

With that being said. I'm an excellent Nurse.Before a factory implements a new machine to the assembly line, time process studies are done to ensure the product can be produced faster and better. Productivity crucial!!!
When human lives are involved one would think this would be absolutely manadatory. Our new computer system has added 60 minutes to my work load. That being a conservative estimate. Every new machine should be tested for efficacy, safety, and time needed to use it as compared to the time needed for the old method.

Posted by Kellyann Curnayn at November 1, 2008 10:42 PM

I read this by way of Tim Walker's Hoover's blog - and may I say, So true, so true, so true!

And never, ever, leave a child alone in a hospital. Never, ever!

Posted by Glenda Spain at November 5, 2008 7:26 AM

Solitude effects personality so badly because we are social animals and we have to join other and can not live alone and for joining other and establishing a strong relationship, people must have attachments styles appropriate for building a strong and positive relationships.

Posted by Kaiser Timothy at November 6, 2008 1:55 AM

Blogging is a spectators sport. I welcome and expect opposition regarding my views! But silence???? The silence baffles me, I welcome to be emancipated of my rediculous thoughts if someone would deliberate them with me. But what I provoke in every Nurse, CEO and health management person is silence. The silence speaks volumes. I opened an area of debate that does not fit our current paradigm. Your right Mr. Tom Peters this stuff should piss you off. Who is responsible for the mistakes that I have made? Of course I am, which is why I wrote the book "A Good Day in Hell", I could complain all day long about the things and people whom seemingly hindered my ability to give good 'care'. But when the day was done; I was the one who went home guilty every day. Every Nurse can recount the errors that have occured over the course of their career, many of which the patient was never aware of. Does any Nurse go into the profession to injure or kill? I am entirely responsible for my mistakes and yet have no power to change my work environment. This is a very oppressive environment to endure hence the behaviors being exhibited by Nurses. I am the athlete taking the blows while the world comments on the bad plays.
Kellyann Curnayn RN

Posted by Kellyann Curnayn at November 9, 2008 3:09 PM

I was concerned to read about the hospital experience described in the article. Where I can understand that patients must be aware of the potential errors and hazards sometimes associated with the clinical arena, I was alarmed to read about the number of mistakes that occurred to the same patient and on the same hospital visit. We do not have any further information to go on other than what was described in the article; however, it does make one recognize the need for a family-member or friend to accompany the patient to the hospital. We must also be conscious of the traditionally competent job that members of the medical team (doctors, nurses, home health aiders, nutritional counselors, occupational therapists, psychologists, rehabilitation therapists, social workers) perform on a daily basis. Alvira Khan, Florida Atlantic University, FAU Boca Raton Alumna, http://www.alvirakhan.com

Posted by Alvira at November 10, 2008 1:21 PM