health, Uncategorized

Le Freak

I’ve had total writers block this past couple of weeks which is very unlike me.  In the end I decided to write a list of all the things that I’d been involved with including snippets of conversations.  I find even the most throwaway of comments can spark something.

What came out was largely service delivery related.  Or in other words, staffing and rota work.  Most people would agree that taking on any kind of rota is somewhat of a poison chalice.  It did take a fair bit of persuasion to get me to become involved in the junior doctor one.  However I strongly believed (and still do) that get the rota right and everything else will fall into place.

Now I’m not going to spend the rest of this blog talking about rotas.  However it did get me thinking about other areas in healthcare that seem easy on paper but somehow never quite translate to that in real life.

Take ward rounds for example.  Why is it that doctors seeing the same type of patients can take vastly different times?  It’s not like the problem is all that different or the initial results any more complex. The doctors themselves have been through a generic training scheme.  The paperwork is the same.  So what is different and why can’t you standardise them to do the same thing every time?

Simple – you cannot standardise people.

What I have seen over the years is that people do unpredictable things especially when they feel they are being forced into something or being backed into a corner.

And therein lies the contradiction in healthcare – we are constantly being asked to change things in order to standardise what we do.  The more you ask people to change, the more likely they are to resist and nothing changes.

I also think some people actually enjoy treading water because it’s perceived as taking less energy.  And let’s be honest, it’s familiar territory so is less scary.

In stroke I teach that recurrent, stereotypical events are not recurrent TIA’s.  If you think through the pathogenesis and mode of action you quickly realise that it just doesn’t make sense (there is only one caveat to this with a critical carotid stenosis but I digress….). However it takes a big surge of energy on my part to stop this cycle of doing what has always been done, revisit the history, explain to the patient what it might be (including I don’t know) and coming up with a plan.  It also takes a lot of energy, trust and faith on the patients part to work with you in this.  The sense of satisfaction when you get it right though makes it all worth while.

If you take this example and think about how we apply it to other aspects in healthcare e.g. organisational change, rotas, ward rounds – it becomes easy to see why the same problems/issues recur time and time again.

So what do we need to do?  Well if it was that easy I wouldn’t be writing this and the NHS would be totally fine…. I do think it’s a bit like what the quote says.  Don’t moan about the problem or expect it to change.  Stop doing what you have always done. Revisit the issue. Adjust your sail.  See what happens.

You might just be surprised……


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