I was left horrified today following a conversation with an otherwise mild mannered and well balanced hospital theatre worker.
We got into conversation about the last post (below), about how our prevailing belief in Keynesian Economics, constant growth and efficiency based on numbers which are detached from reality provide us a cultural acceptance for 'Target Driven Behaviours' ..... and the negatives this leads to at a deeper level.
This mild mannered chap suddenly became animated, passionate and upset.... the reason? His recognition of the term 'Target driven behaviours' and the tragic effects he has witnessed 1st hand working in the NHS.
The worst of it ... he has lost friends to suicide and puts the blame firmly at the door of 'efficiency targets', driving high stress levels and desperation in skeleton staff, tasked with achieving the impossible on long shifts to satisfy a target and a budget set by people in offices, detached from reality having never done the job themselves.
He states 'List's' are generated and they have to be achieved, no matter what, people are forced to work through breaks to 'achieve the numbers' and he has even heard anaesthetists told (in anger) to just eat in theatre because 'we haven't got time to stop'.
He goes on to say the one thing that isn't considered is the length of the list or the possibility of reducing it. He also mentioned that it is often the case that nurses are overworked and can't cover all the wards sufficiently during their shift, often leaving patients in danger because they can't be attended to adequately. (He then quoted the case of the chap who died of thirst on a hospital ward in the headlines a couple of weeks ago).
This matches my own experience. When my wife;'s grandmother was in Addenbrookes, shortly before she passed away, a lady in her 90's had half fallen out of bed, I tried to help her and got warned off by other visitors, stating I'm not allowed to touch her in case I'm accused of anything!!! I found something to help her lean against and comforted her, then went running out into the ward. It was 7pm and there wasn't a single nurse on the ward, it was deserted. I went running down the corridor to find a nurse, after a frantic 2 or 3 minutes tracked a single nurse down, asking her to 'Come quick' ... her reply ... i'm not allowed to do anything with patients on that ward, I'm not trained ... I eventually found a nurse who could help and the lady was put back into bed. The nurses that did eventually help said it wasn't uncommon and that they have to become hardened to it or they couldn't do the job at all.
My Theatre working colleague then quotes increasing issues of mistakes during operations, swabs being left inside people and wonders in overt disgust that these stress related performance capabilities are not linked to the primary beliefs on which we build our fiscal business models of efficiency.
I heard last week that a politician somewhere was looking to shut hospitals to save money, suggesting that we don't need hospitals so close together ... really!
How much more detached can 'leaders' be before we recognise there is something fundamentally failing, and failing in complex ways the current and simplistic approach can't recognise?
How much more can we pursue efficiency in predicted numbers to the detriment of the effectiveness of people, which, when 'good', can lead to real efficiencies in practice .... when are we going to recognise an ERP / MIS / CRM system or spreadsheet is 'logic only' and doesn't work in reality, especially where the logic of it all is used to 'control people', setting imaginary targets that can't be met without having a negative knock-on effect in a complex socio-technical system?
And of course this is only one example among many ... and not only from within the NHS ... every industry is infected with this disease and it's killing people!
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