Somethings patients don't know about...
The way medical treatments are actually delivered, varies a great deal more than patients realise.
Two identical patients could both have the same procedure in two different hospitals, and receive very different treatments. Even when both hospitals are in the same city.
These differences are connected to structural issues such as -
- How the hospital is actually funded (public, private, not for profit)
- The management structure (is it owned by a group of surgeons who work there, a private board or a government department)
- How much staffing is actually allocated to patients (are medical staff available after hours, how many nurses are rostered to patients)
- The educational standards of the medical and nursing staff (are the specialists over 10 years past final graduation from University and have they done any future training? Do nursing staff hold university accredited post graduate qualifications when working in specialist areas?)
- The strength of the hospital management team to deal with difficult issues (can they discipline and sack bad Doctors or nurses). Both Medical Associations and Nursing Unions are extremely powerful, and disciplinary action against their members requires strong leadership.
The ‘nuts and bolts’ of patient care is not usually documented, regulated or standardised.
In general, large inner city public hospitals have created their own in house 'policy and procedure manuals'. These refer to general patient management such as education, staffing, drug dosing, clinical management in dangerous situations o and reporting procedures.
Smaller and private hospitals usually only keep limited documentation that has been created by large bureaucratic bodies. These might include generic health and safety guidelines such as the cleaning of hazardous waste and maintenance of fire procedures.
The public have no idea that these documents even exist. But patient advocate groups are well aware that these is a surprising difference in the quality of care that patients receive.
These differences are referred to as ‘unacceptable variations in care’.
By comparison, the United States of America and England makes extensive information about public about different hospitals performance. You can see which hospitals are rated the best by Doctors, by patients or by hospital error ratings.
In Australia much of this information is collected by bureaucrates, but it is kept secret from the public.
This secrecy makes it easy for Australian hospitals to avoid the difficult tasks of reform.
Inadequate nursing staff working in a private hospital
An agency nurse was contracted to work a late shift (1pm to 9.30pm) in a small private hospital.
A number of patients were being taken into theatre for surgery in the afternoon (on the pm list). However many of the nursing staff had been sent home after 5pm.
Hours outside 9am to 5pm attract penalty rates.
A patient was due to come out into recovery at 7pm after surgery for a fractured hip. By this time the agency nurse was the only staff member working in the recovery unit. There was no backup if the patient experienced a problem like a blocked airway.
The nearest doctors and nurses out of sight, in another area of the hospital.
Concerned about patient safety, the agency nurse refused to accept the patient into recovery until at least one other nurse was brought into recovery.
The agency nurses rational that if the patient deteriorated and had an airway blockage, she could not care for him safely.
The doctors and nurses in theatre were extremely frustrated and the bed manager was called in.
“Nothing had ever gone wrong in the past”, she assured the agency nurse. “It is perfectly safe to have only one nurse in recovery”.
The bed managers overwhelming concern was controlling the hospital budget and keeping the private surgeons happy.
Delayed surgery meant unhappy private surgeons and the extra cost of hiring more than one nurse to work in recovery.
The agency nurse dug her heels in, and still refused to take the patient into recovery. She was subsequently sent home.
She was never reemployed by this hospital again. The private surgical patient had no idea that he would have had a higher ratio of nursing staff to care for him, if he was treated in a public hospital.
There are many stories like this shared among Doctors and nurses.
- Patients don’t get to hear about them
- The media doesn’t report on them
- Politicians and bureaucrates ignore them
Safe hospitals are dependant on many factors.
The biggest one is transparency.