Deja Vu

Yet more abusive treatment in care

Abusive treatment of the elderly in NHS hospitals reported today by the Patient Society.  Now where have I heard this sort of thing before?

Oh, I know, Winterbourne View, Southernn Cross, McIntyre undercover report into care homes in the South East and on and on.  Will it ever stop?  Probably not. Can it be reduced?  Definitely

How though?

The reality is, that as damning as this report is, and as "horrified" as we all are and no doubt politicians and the media will now ask for an "urgent review" or "public enquiry", the answers are fairly simple.  This is a waste of time and money and has been done before.  Have a review,report,enquiry, but doing it on the people succeeding and find out why.

We need an attitude change

• People who are elderly, infirm, disabled, forgetful, incontinent, angry, sad, mentally ill, learning disabled are all defined by the first word in this sentence.  They are people.  We need to stop demonising those that aren't "tax payers" or treating people who are disabled/elderly or both as if they're a "drain" on the rest of us.  The reality is, that we, if we live long enough we will fall into one, other or both of those categories.
• Staff need to be trained to smile and greet.  It's not a five star hotel, I realise, but, if they did smile and greet, rather than avoid eye contact and scurry away from patients/visitors etc, then they'd probably encounter far less hostility from people who are confused, angry and possibly in pain.
• The public need to be educated on how a hospital works.  The nurses aren't all on lunch break ignoring you, they're often doing paperwork which may seem like a waste of time, but will probably mean that your appendix gets taken out rather than having your quite useful arm being removed by accident.  Or that they don't give you a drug that might kill you.  Paperwork is meant to eliminate mistakes.
• Someone asked on twitter, how much does it cost to learn some one's name?  Well, obviously nothing, however, patients also need to realise a number of things
• Staff might see well over a thousand patients a year and therefore remembering names is difficult and for some people they're just not that good at it
• Becoming attached to people who might die  on their watch is actually traumatic for the staff, so they develop coping mechanisms, one of which is detachment.

We need to find the best leaders in the NHS and get them to train/mentor people

• Stop demonising great leaders for earning a lot of money.  They earn a lot of money because they have got there through hard work and skill.  Let's pay them more and get them to mentor those who could be great leaders!  Show the others what they do that makes them good at what they do.  Why do some hospitals have smiling staff, motivated people and a great attitude, while others are a cesspit of despair?  Leadership. 
• Leadership is not always about the person in the top spot though, look to promote team leaders who are not only good clinicians, but good leaders as well.
• Go to The Christie in Manchester and wander around, staff smile, people are treated properly, it's confusing and intimidating because it's a hospital, but, even though it's a cancer hospital, people smile, ask how you're doing and if you look lost, will ask you if you need help! I'm sure they also have their problems, but, in my experience they are very good.

Stop looking at what we are doing wrong and move towards what's being done right.

• Let's have a review of the best performers, note what they do which can be recreated or adapted elsewhere.  Look at A&E departments with efficient systems and recreate them.
• Be positive and look to change the hospital environment to reflect that. 
• Get people to report positive care, don't just have a whistle blowing policy, have a trumpet blowing one as well!  If someone has done a great job, let people know!
• There is a plethora of research on leadership and staff motivation.  Use it!  It's not about profit, it's about training, maintaining, motivating and retaining great people.  Every great leader or clinician that walks out of your hospital is a tragic loss.  These are the people we need in every walk of life.  People with charisma, intelligence, focus, purpose and most importantly empathy.

We need to stop looking at hospitals as a purely clinical environment

• We have spent years treating the whole of the NHS as if it's the waiting room of the A&E department.  In the media it is all about MRSA and waiting times, this has lead to all the focus being on cleanliness and getting people in and out quickly.  The reality is, often those people who are coming in are intimidated by their surroundings, intimidated by the intelligent people in white coats and scared because there is something wrong with them.  If they're also confused due to illness, age or disability then these problems magnify.  
• If you feel powerless over what's happening next, then, no experience is going to be positive.  Patients need information about what's happening and when that might be the case.
• I realise that you can't give exact details about when the doctor might get there, but even that is important to tell the patient, keep them informed and treat them the way you'd wish to be treated.

Secret Shopper

• A simple suggestion would be to get the head of every department in the NHS to be admitted to another hospital as a secret shopper to find out what it's like.   
• Have them go as a potential patient or as a relative or perhaps even just walk in the front door.
• Staff in hospitals forget that people arriving at hospital don't have the same experiences as them, they are at work, like the rest of the working population, going to work is often an emotional drain, and might be stressful, but you know roughly how your day is going to pan out, a patient on the other hand is reliant on a vague schedule that they have no control over.  
• I suspect that this idea alone will improve hospital treatment of patients massively.