We all agree that having healthcare standards is a great idea. But what if those standards no longer reflect society? We give a four-point RoadMap that every hospital and surgery should follow.
It’s a truth universally accepted that hospitals, and healthcare in general – are not keeping pace with the demands put upon it. The common excuse, equally universally trotted out – is that – well, – there are just too many people, too little funds. We all live too long, and there is less porridge for the three bears. Goldilocks will have to wait for the second sitting.
It’s a lovely story, if only it were true.
The unfortunate facts are that there are plenty of new advances in clinical improvements. Dozens of brilliant apps that monitor and send your health data wherever it needs to go. And more than enough new ways of managing yours and my health processes, better than we have ever done it before.
So what’s the problem?
What it comes down to is – unless you are one of the very persistent few – almost equally universally, none of these advances will ever get taken up. They get squashed and quashed under the mountain of fear of making change. As they used to say in the sixties, nobody ever gets fired for buying IBM. Or not adopting anything else.
And the excuses are many and varied, and they range from – “well, let’s wait until the hospital down the road does it, and we can see how they get on” – to (and this is my favourite – ) “we only ever procure when there are two of anything”. Which means that, by definition, advances that are ground breaking – and that may well be fully tested elsewhere – will never see the light of day because of their very uniqueness.
Somehow, the reliance on rules that might have worked once, has metamorphosed into a protection for the hospital, and an obstacle for the patient. And its a funny thing.
Fear of making change is manifested in various ways. The obvious and simple one, is the routine adherence to protocol, to frameworks, to rigid pathways. It is what I call the “Baby P’ scenario. What if the patient could have been saved? Not our fault. We were following the rules, mate!
I totally “get” the need for a fixed process. Any large institution – and there are non larger than the UK NHS – need a clear process, that guarantees basic universal care. But this attitude, of either passively putting up a barrier – or increasingly alas often, proactively putting up barriers – and that we see so often in this sector, far from leads the way into better healthcare. It guarantees that we stay stuck in ways of behaviour, of technology that simply does not work any more, and that puts lives at risk.
This is most prevalent in areas such as Diabetes, or in theatre management. And now more recently, in telephony and call handling. Hands up the last time you got through to anyone in less than five minutes?
We are not talking about small numbers here. Whole regions are seeing exponential rises in costs, because of a simple refusal to adopt new proven practices. The growth in personal health data, smart watches, means that you and I and the rest of the civilised humanity, have already invested personally in devices that can save us. We just want our hospitals and clinics, to do the same. After all, they are actually paid to do so.
If I asked earlier – what is the problem – then what is the answer?
First – throw away the reliance on frameworks. They are our of date. In the modern world of open metadata access and speed of data delivery, hospitals can make instant judgements on any mix of criteria.
Second – ensure you have a process for adopting new technology, particularly mobile based. Look for the solution to a clinical problem, not wait until you are forced to make a choice.
Third – ditch the protocols of management behaviour. Look at each individual scenario.
And Fourth – recognise that society itself has moved on, and demands better from its professionals, – and that it is right to demand better. There is no value for a hospital of surgery in only defending it’s interests. We pay these institutions to defend our interests, not theirs.
The fact is – as we have described earlier in these pages – healthcare has moved into a Community setting, where prevention and early diagnosis can be identified so much earlier and faster. This has meant a sea-change in attitudes as to where to spend money, and a battle between the various silos of the whole healthcare process, to protect their own individual pots of money.
So where do we go now?
First, we need to recognise that this article is simplistic – that the divisions of primary care and secondary care – of CCG and Hospital, are ingrained. And whilst this article puts the onus firmly on hospitals to change management attitude – it may well be the outreach of a proactive CCG that determines where our healthcare is going.
Perhaps surprisingly, despite the issues of the above reflections, there remain plenty of hospitals and clinics that do indeed follow these mantra, who each month have a clear day where they review technology, who engage with non-NHS organisations in order to get a wider and more critical view. As my colleagues in Edinburgh NHS tell me – “if you always do what you always you did – then you will always get what you always got”.
At a time when there is pressure and PR to invest more financially – the need right now is be brave, in our view – and redefine the structures.
Because without this – patients will increasingly vote with their feet and go into some sort of private scenario, and slowly but surely, the management attitudes and strictures that drive the NHS at all levels, will bring itself down. Don’t say I didn’t warn you.