Sunday, July 01, 2012

Lessons from a taxi driver

I took the train from Ipswich to London this weekend for a break between my first and second week of lectures and workshops at Ipswich Hospital.  En route to the train station, I received a running (and unsolicited) commentary from my taxi driver.  As we drove by the hospital, she gave me her idea for process improvement there (knowing nothing about my background or purpose for being in Ipswich.)  It was something like this:

My mother was in the hospital a while back and I noticed, when picking her up to leave, that patients often sat in their rooms for 4 or 5 hours waiting to be discharged.  They were all set to go but just needed some test result or medication.

What a waste!  Those rooms could be used for someone else.  All it would take would be to have the hospital electrician -- who is on the grounds anyway -- to string a wire for an emergency buzzer, and buy a few easy-chairs for a couple of hundred pounds.  Then they could wait there comfortably and free up beds for others.

Well, I took it upon myself to write to the Chief Executive.  I didn't get a reply but I noticed in the newspaper a week or two later that the hospital had decided to create a new discharge lounge, ad so I felt like someone had actually listened to me.

But then I learned that instead of just stringing a wire and buying a couple of easy-chairs, they had spent a ton of money on building a whole new section and hiring nurses and nursing assistants to staff them.  I guess when you have other people's money to spend, you are likely to spend more!

I am guessing that it was regulatory requirements rather than a desire to spend other people's money that led to the hospital's design and staffing decision on this matter.  After all, until a patient is formally discharged, s/he is still a total responsibility of the hospital.  I would have explained this, but my voluble taxi driver was already on to the next topic.

But the story reminded me again about the interest that family members and patients have in being helpful to their local hospital.  They might not always have enough knowledge of all aspects to correctly frame the solution, but they have good instincts and perspectives on how the care environment might be improved.  (See this example from my former hospital's ICUs.)

It behooves all hospitals to create a process by which well-intentioned and thoughtful constituents can be heard and integrated into the clinical care process and setting.

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