Sunday, 12 June 2011

View from an inpatient bed (1): The one about accountability

This could be titled – the one about the tissue. It was a tissue, spattered with tiny spots of blood lying on the middle of the ward floor that caught my attention at 6am on the first of my three days in hospital.

The hospital ward appeared spotless – and, as I found out later, was cleaned thoroughly at around 10am every day. But that wasn’t the point.  The footfall in the four-bedded bay was multitudinous for the first few hours of the day. A nurse changing my IV, another doing the drug round. The lady who brought tea at 6.30 and breakfast at 8. A team of nurses on their ‘changeover round’ at around 8. The man who brought the clean water jugs. A surgeon and anaesthetist visiting a pre-op patient. The healthcare assistant who did the observations round at 9. The volunteers who changed the bed linen.

Each and every one of these individuals either failed to notice or chose to ignore the tissue. Nit picking? I don’t think so. It made the bay look untidy and posed a potential health hazard. So why did no-one pick the flipping tissue up and put it in the clinical waste bin?

Ownership and accountability. Who actually ‘owned’ the bay? Who was accountable for each patient? Each operative in this apparently efficiently run unit were very clear of their roles and responsibilities. And this is the problem in compartmentalising care, even at this level of minutiae.

My daughter undertook an excellent post graduate training programme in bar management with a large hospitality chain. One of the first things she was taught was responsibility for everything that happened in the bar. When she moved into management she encouraged a similar approach with her staff. Torn menus, dirty tables, rubbish, even toilet roll in the customer bathrooms. Each member of staff was encouraged to take personal responsibility for the customer environment. Likewise with my pharmacy training – university and post graduate, it was constantly drummed into us that we were ultimately responsible for everything we dispensed.

Another point only struck me after my discharge. During my stay I was ‘touched’ (in many cases literally) by at least 50 staff, clinical and non-clinical, night and day. I should be very appreciative of this intense level of interaction and I am. But although each task necessary for my wellbeing and recovery was undertaken with kindness and efficiency, the cause of my admission (ear) was only actually looked at by the consultant on his daily ward round. It would have been nice if the people administering the drugs and my daily care showed some level of interest in whether the treatment was working.

And not once did someone ask me ‘how are you feeling today?’

In my previous blog I talked about the benefit of a time and motion study, to look at the way care is delivered and find efficiencies. This should go hand in hand with training on accountability. Ownership of the environment (whether it’s a GP practice, health centre, or hospital department), ownership of the patient and a holistic approach to their treatment, both medical and pastoral.

And the tissue? My control freakery took over and after 3 hours of observation, I cracked and picked it up myself.


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