Saturday, June 13, 2009

Web of inclusion - or circus of confusion.

Sally Helgesen ,a US writer, in her book "The web of inclusion" described how a revolutionary way to organise work in the famous Beth Israel New York Hospital created a new philosophy of patient care and became a world wide movement. Breathtakingly simple, the new system assigned a single senior nurse, known as the primary carer, to each patient. This nurse would manage that patients hospital stay by forming a care team made up of everyone from housekeeping to Laundry, junior Doctor and Senior Consultant. The care team consult as one on the patients therapy or surgery with each part of the hospital chain connected together. Helgesen likened the system to a spiders web where the beauty of the whole structure depends on the links between each part. The benefits of Primary Care Nursing as this is now known are many; Trainees learn by involvement, Domestic staff develop pride in their work, The Primary Care Nurse bonds with the patient- and Consultants practice humility because, uniquely, they have to consult. The patient is treated as customer, guest, client and centre of attention. The model has been adopted by commercially focussed hospitals and those with a patient-centred ethos the world over.
Earlier this week I attended Blanchardstown Hospital to have an arthritic joint (a recent running injury to my right foot) injected. My appointment was for 7.30 am. I presented myself on time, filled in a number of forms and handed over my health insurance card to the consultants secretary. Some eight to ten others assembled simultaneously, likewise answering a 7.30 appointment, without any particular order to proceedings. I was called into a day ward after only a few minutes, given a cubicle and the usual flimsy backless gown, and told to undress and put this on. I mentioned that my big toe would be the consultants only focus today, hence there was hardly any need to undress, but was told by the senior nurse " It doesnt matter, its procedure". I was then asked to put my shoes back on and go to X-ray. I pointed out that my boots were painful to put on and take off and in any case the foot itself was the point of X-ray. The answer to this was " sorry, health and safety".
After the X-ray was taken I returned to this day ward clutching the film of my painful big toe. I had not by this stage seen my consultant or been given any indicator of when I would get my injection -a ten minute simple procedure in itself- so I mentioned to the nurse who appeared to be " in charge" that I had an equally important 12 o clock appointment with another consultant in St James hospital. A rare abundance of medical attention for me I can assure you, but an appointment I had waited for and would have to wait two months for again. I was reassured that I would be out by 11 and settled down to wait for the big toe man to call me.
Some two and a half hours later, at half past ten, this nurse reappeared apologetically to say I would have about another half hour wait and might need to cancel my other appointment. I considered my options for a few minutes and then reluctantly rang James' to explain my predicament. A very understanding receptionist promised to reschedule me, albeit to some time next month. Again I settled down to wait.
At five past twelve I rang my own receptionist to make other plans. My own efficient lady rang me back to say an orthopedic man in Clane would see me at half twelve next day. So I got dressed. At the ward desk I asked for my X-ray back and stated I couldnt wait any longer.
To the senior nurse who appeared gob-smacked I said " I am afraid this is probably one of the reasons why the public have lost faith in the HSE". A Student Nurse from meath whose dad was a farmer had chatted to me earlier about Aberdeen Angus cattle and Meath GAA while she brought me down to x-ray.I thanked her and said " Niamh, this is called voting with your feet- Some day I may be so sick that I have no choice but to put up with this ; but today I have a choice so I am not going to be treated like this and then pay out my own good money to the man".
As I limped out onto the corridor I got a surprise as the embarrassed consultant himself came out of a theatre door after me. He apologised for the delay with a defence that he had got bogged down in a surgery and hadnt been drinking tea in there.. I said, look, there is no argument, you are busy but so am I - I was here at 7.30 for a small procedure, it is not acceptable to have to wait five hours without warning, you cant treat people like that any more.
He was also told how disorganised the place was and how disrespectful it is to herd in your whole day list at 7.30 am with no order or communication- and in an off-hand manner to force me to miss another important medical appointment for no good reason.
He did apologise again profusely but in reality the loss of a private patient was likely the only thing to exercise him to rush into the corridor after me.
When Kildare Vet Surgery was built in 2004 it was built at cost to one person-me- to provide a service to animal owners, to work to a high standard, to become a local asset and social benefit, to raise the level of animal care in Kildare to a new level- and to be a commercial success.
We work to a mission statement - Aiming to provide excellence in Veterinary when you need it near you.
This mission statement is client-centred. Our success and survival depends on attention to customers. Excellence in Veterinary is something we strive for as we deliver the services the market demands.
If a client or their pet are unhappy with us in any way we can and must be told - and if we are not responsive to customers needs or wants then we dont have the right to that customers business.
Questions arise from that trip to Blanchardstown- Did the Nurses even bother to tell the consultant I needed to be out by 11? Did they place any value on my time and the wasting of my time? Did that consultant ever have to bother before about disrespecting a private patient or any patient?
Plainly they have a culture/ethos/policy of not treating patients like customers.
In fact they barely treat their patients as adult human beings as far as I could see.
If the HSE in Ireland or even just Blanchardstown Hospital were to adopt a client-centred policy, as Vets like myself who have to make a living adopt client-centred aims, it would have to be called patient-centred and would use many of the strategies of the Primary Care Nursing movement.
For this to happen, many more paying customers like myself will have to vote with their feet, will have to get up and walk out and will have to calmly face to face with these senior Nurses and Consultants say- I will not be treated like this and disrespected by you and your flawed system and your archaic hierarchy.

Des Groome

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