Performance Assessment

DSC_0046I can’t help mulling over the experience even after the end of my stay at Charing Cross hospitals. I am sure that some of the overhead in paperwork and staff is caused by the desire to measure and monitor the nurses’ performance.

Based on my own observations, here are a few suggestions to measure that easily and reliably.

Measure the minutes a nurse spends in the patients’ room and divide by the minutes spent chatting in the pantry or in the hallway.

Measure the average distance and average speed walked.

Consider the case of medicine which needs dissolving in water. Distinguish nurses who place the sachet of powder on the patient’s nightstand from those who actually fetch water and dissolve the powder, and again from those who also run to get a straw for stirring such that said powder actually dissolves.

Consider the case of a day old bandage with fluids beginning to seep through. Distinguish nurses who point-blank refuse to change the dressing following a close inspection from a 4 meter distance (not until it bleeds through) from those who change when asked, and again from those who change the dressing unasked and even offer spare dressing.

I experience the full range of the scale, and find the width of the gap astounding.

Here’s a flower for those who rank at the top of the range. They would know who they are if they’d read this.

Piece of Resistance

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In my last report from under the covers at Charing Cross hospitals, I can reveal the final piece of resistance.

I am in fact writing this article after my discharge from the hospital and safe return home for the time being, but that’s already the point. The fact that I managed to get discharged and that the joint forces of the NHS managed to set me free is astonishing, if you consider the time line.

12:45 Doctor decides I can go home
16:15 The pharmacy is now preparing my medication
16:30 First portions of paperwork arrive at my bed
17:15 I am free to go

I am free to go within only 4 1/2 hours. 4 1/2 hours for printing a two page form, collecting a few signatures and dispensing a small collection of standard medication. A clear and fine win for the bureaucrats, methinks.

 

Patient Focus

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In my penultimate report from under the covers at Charing Cross hospitals (I am in fact back home by the time this post goes live), I want to share some thoughts about patient focus.

I am sure the NHS, Charing Cross hospitals and the architect and interior designers of this particular home away from home (ward 10 South) are all very proud of the comprehensive patient-focused design and layout.

But that’s exactly what it is: it is focused on the patient and allows for the best possible care. But, did anyone try to see things from a patient’s standpoint of view? Apparently not, or not successfully so. There’s amble space for the nurses to look away drugs and materials next to the bed but little room for a change of clothes. There’s amble space for nurses to assist or come to the rescue in the bathroom, but little room to put a towel and no place to put a bar of soap or bottle of shower gel other than on the floor. Needless to say that I am not allowed to bend down. There’s a request to take only lukewarm showers but no temperature control is available in the bath, only all or nothing.

It seems that the designers were focusing on the patient too hard and failed to imagine themselves in that place.

Papers, Papers, Everywhere

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I am reporting from under the cover at Charing Cross hospitals, being submitted to a ward of approximately 30 beds.

Patients are being looked after by a handful of nurses and health care assistants. There are also cleaners and those taking care of the meals. And there are a lot of paper-shufflers, that’s for sure.

Just take a gentle stroll around the ward in an attempt to get some circulation going, and you’ll find half a dozen of people at least, at any time of the day (but not the night), either standing around in important conversation or waving impressive paperwork. Most are easily recognised by their plain dress or the uniform designated to the upper ranks, armed with a biro, a bundle of forms and folders and a good deal of importance.

I am guessing there are at least as many paper shufflers on duty as there are people doing actual work.

Diet: Standard (Bulk)

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While I hold residence here at Charing Cross hospitals, I am officially on Diet: Standard (Bulk).

That’s what the printout states, and I think it is a fair description of what is being offered and served.

What goes as salad consist of a small handful of shredded Iceberg lettuce, half a industrial tomato (red but hard and flavourless), a spoon full of the main ingredient (caned tuna, shredded chicken, etc) and two packs of salad cream. I spotted a sweet corn on one occasion, but maybe that was a case of cross-contamination from a different dish. A ploughman’s salad didn’t come with bread, but a side order of a mayonnaise-rich potato salad was available. The omelette, documented in the printout on the left, didn’t come with most of the requested side orders. The omelette itself was dreadful, dry and cooked to death. You would think they’d make an omelette fluffy and nice by stretching the egg with milk, but no.

At the time of this writing I am on nil by mouth. Not the worst thing to happen, I think.

Are You Alright?

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I am undertaking a bit of investigative journalism for you and selflessly submitted myself to the NHS (national health service) and to Ealing and Charing Cross hospitals in particular for solid under cover research.

All in all the experience is a lot better than what media makes us believe. That must be said.

I didn’t experience prolonged waiting for treatment or ambulances, no standing around in cold hallways or wards in disarray. All staff is friendly and helpful, even though some nurses need prompting at times. Don’t you think the dressing needs changing? Don’t you think you could give me some water give that you insist I drink lots of it? Things like that, but all in all good.

The food, however, is everything the media makes us believe. A healthy and balanced nutritious diet seems hard to come by, even if they manage to deliver a whole meal complete and as requested. More often than not, parts are missing. Maybe it is better that way.

Fit Note? My Arse!

DSC_0802I didn’t need to see the doctor, but as last week’s feverish cold took its time, I took a moment to check the rules as to when I had to supply a sick note for work.

Fascinating fact #1: it’s 7 calendar days in the UK.

Fascinating fact #2: it’s not a sick note any more. It’s a fit note, supposedly confirming that you are fit to work or, as will be the case in almost all cases when a doctor signs such a document, it will confirm that you are not fit to work on medical grounds. Also known as sick.

I find that pretty annoying. Some political spin doctor thought it important to change the well-established name sick note into fit note. Something about the psychiatry of being positive, I guess. By the time this was discussed in all committees involved, by the time the decision was communicated with all parties and doctors involved across the country, plus the general public, by the time related documentation (and the new Fit To Work forms) was changed and printed, by that time, hundreds of thousands of pounds will have been spent on a change that makes no difference no whatsoever to nobody nowhere at no time.

 

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What’s Your Name?

another not-so-bright fellow One particular detail about my recent hospital visit fascinate me though. It goes like this:

Whenever health professional A hands over a patient to health professional B (which, as it turned out, happened quite a lot), they need to go through a ceremonial dance to confirm that A brings the correct patient, that the correct wristband is still attached to said patient, and that B then obtains the correct patient.

It seems a little over the top, but I am sure the ramifications of cutting off the wrong part of the wrong patient could be unpleasant. So, OK, I go along with it. Not that I have a choice anyhow, but you’d wonder with all that scrutiny applied, at least they could try to do it right? You wish:

Sir, are you Mr so-and-so?

Yes.

Sir, are you born on the such-and-such of year so-and-so?

Yes.

Sir, do you live in this-and-that street?

Yes.

There were times when they could have asked whether I am the Queen of Sheba and I’d have said yes. Everyone who ever read a mystery novel knows not to ask suggestive questions. How hard is it to ask

What’s your name, sir?

 

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A First, at Ripe Age

another chap of ripe age Funny that in all those many years, I never had surgery done, not as far as I remember anyhow. Well, now I have. The surgery was a low-risk thing and, as such, no cause for anxiety and worries, but it was very interesting to experience the whole thing.

First, the check-in to my day-case hospital treatment. I approached the receptionist, stating my name and claiming that I had a reservation for a room with sea view. Turns out they couldn’t deliver the sea view, but a nice long view overlooking a park and golf course, then the new Wembley stadium, with the London Skyline at the horizon (the docklands with Canary Wharf and the London Eye were clearly recognizable). So far so good.

Then, a long series of being fussed over. Temperature, pulse, weight, medical history, lunch menu choice, blood test, and similar jobs kept me entertained for a while, until I was laid down flat on my back, wheeled through the hospital, asked to breath deeply, and then be told everything was over.

(Followed, of course, by a a couple of hours of boredom until discharge.)

Fascinating.

 

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A Doctor Each Day Keeps My Work Away

Chiswick House I had need to see a specialist doctor. His clinic doesn’t make appointments, but operates on a 9 ‘o’clock first-come first-served walk-in basis. OK, I thought, I’d better be there in time, and arrived at the machine where one pulls the ticket number at 8:15.

The room was already half full of people smarter, and even earlier than me.

The receptionist arrived at quarter to nine, and the first question was “who’s got an appointment?”

What? I have never found out how one gets an appointment on the no-appointment Monday morning walk-in clinic, but never mind. Turns out I was number 14 in the no appointment queue, and when it was 9 o’clock, the exact time when the clinic would officially open its doors, they announced that  they were now fully booked for the day, and started turning people away.

Luckily, I had gotten in earlier. I’d be fuming with rage otherwise.

After only 90 minutes, I got called and transferred to another queue. Arrangements there were less comfortable, but people were in better, and humorous, spirits, after realising that this is just another queue.

I was seen half an hour later, and discharged 10 minutes later. All right, I got the assessment I came for.

Next time, I’d like to provide an assessment into their work, though. I am sure there were lots of things going on that we didn’t know or understand, but the number of times my file was picked up, looked at, put down again, the number of times nurses and doctors walked up and down the aisle – I am sure that I don’t understand half of what is going on there, but I can’t believe they organised themselves, and a whole room full of patients, in the best possible way.

Anyway. I got out of there and back home in little over 4 hours. This will probably beat the official NHS target.

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A Pain in the Back

DSCF6611_JPG_595 NICE has now approved of acupuncture, to be subscribed on the NHS once traditional means (such as injections of various kinds) have failed to cure back pain. Other secondary methods of treatment include physiotherapy and some-such.

I am no doctor as you know, and I certainly acknowledge that many people suffer from genuine and chronic pain in the back.

I am, however, vaguely aware of the great British furniture, and thus suggest NICE should consider supplying good quality ergonomic desk chairs, firm sofas and very firm latex mattresses.

I’m pretty sure this could do wonders and avoid much of the pain, and the costly treatment required later.

Too bad they never come and ask me what to do.

 

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Poor Standards

Cancer Research fundraiser
Did any of you watch this last Sunday’s Panorama program about Herceptin?

No, you haven’t? Consider yourself lucky, for you have missed a sub-standard piece of subjective, single-sided, poor journalism.

There was a lot of talk about and from those women who desire Herceptin, as it appears to have good chances not only to extend lives but also to cure breast cancer, when given in the early stages. I have sympathy with those women, but one must of course look at all aspects of the story. This is where Panorama failed.

Some NHS representatives had at least an opportunity to explain that allocating resources for the purchase of this very expensive drug means to make cuts elsewhere, and it was also explained by some that this drug is not yet licensed for the use desired by these women.

The obvious next question would go to Roche, Herceptin’s manufacturer. Why does it have to be so expensive? Is the cost of development and production really so high, or is Roche adding a very generous profit margin? Is guess so, but Panorama did think this worth questioning although the cost of the medication was a re-occurring theme throughout the program.

Further, no one questioned Roche just why the license for early breast cancer treatment hasn’t been applied for yet. We only heard a brief mention of "soon", but again, no interview with, or statement from, Roche. Their patent on Herceptin runs out in only 5 years, so they will be keen to bring it on the market for this second indication. I guess they have good reasons why this hasn’t happened yet, but again, Panorama didn’t care.

Further, once Roche will have applied for the license, we were left in the dark about the time this process might take. No government or NHS representative was asked about the duration of this process or how it could possibly be sped up.

We did get a lot of tearful emotional blackmail, though.

Watch out for the continued press coverage on subject matter. My guess is, as the Panorama program subtitled, that those who shout the loudest win over reason and good standard procedures. They certainly won over good standard journalistic procedures.