Bruce Cotterill: What I learned from a day observing the health system

OPINION:

It’s Monday morning. 10.30am. The Euro 2021 football final has just finished.

My phone rings. The voice on the other end tells me that my mother is in an ambulance on her way to hospital. She’s had a fall, and her already troublesome spine is causing immense pain.

I tell the caller I’ll be there as soon as I can.

It takes a couple of hours to excuse myself from a meeting, re-organise my week and cancel a couple of commitments that I had already made. I pack a bag and get on the road.

It’s a three-hour drive to Tauranga with the traffic. One I’ve done plenty of times before. I drive straight to the hospital in my old home town.

My enquiries at the reception desk lead me to the Emergency Department, or the “ED” as they seem to like to call it.

I walk in to the ED waiting room at 4.45pm. It looks like a war zone. There’s a guy in his English football shirt with blood pouring out of his head. There are people coughing and sneezing. Some are on crutches.

There seems to be a lot of babies. Many are crying. One is howling. Some are crawling around the floor. I have to step over two children, each perhaps 18 months or 2 years old, who are lying on the tiled floor in front of the reception desk.

I brought a mask with me. I thought it would be necessary. But no one else is wearing one, including the staff, so I don’t bother.

Eventually the battle weary receptionist looks up at me. “Welcome to the madness,” she says with a wry smile, as if her sense of humour is all that’s keeping her going.

I tell her who I’m looking for and she immediately jumps out of her chair and takes me to my mother’s bedside. Her bed is in a corridor. Opposite the ED control centre.It’s now 5pm. She’s been here since 11.30.

We wait. And we talk. I learn that the ambulance took two hours from the first call. She tells me she’s had an X-ray, but nothing else. I ask what they’re doing with her, and she says she doesn’t know. I ask if she’s been offered any food. She hasn’t.

I start to observe what’s happening around me. We have a great view of the control centre. After all, my mum’s bed is almost in the middle of it.

Harassed doctors, nurses and orderlies hurry past. Many smile or say hello. Some try to but nod politely and look at the ground. The more I try for eye contact, the more they look away.

They’re busy. To the point of being out of control. But no-one loses it or even raises their voice. They just keep going. I start to wonder how they do it. I start to wonder why they do it.

I’m trying to get their attention. My mum needs some pain management. Finally I catch the eye of a nurse who helps us. She’s apologetic and efficient. She looks at the patient chart and for the first time she tells us what will happen. It’s been seven hours.

They’re busy because a lot of the people here don’t need to be here. A kid with a cough. A woman who says she’s broken her leg but hasn’t. And a group who think it might be fun to accompany their injured friend.

Meanwhile, crying children continue to provide the background noise. I chat briefly to another nurse about how crazy this place is. She quietly says to me that “there are other places they can go”. I get it.

The man in the football shirt has had his head stitched and is on his way out. I overhear a woman being told that there is nothing wrong with her and she’s okay to go. A couple of the beds have been emptied and finally we’re taken from the corridor to a room.

Eventually an Orthopaedic surgeon turns up with a student doctor alongside. He explains that they will check some recent scans and the X-ray results. They’ll then be back to ask some questions and to take a look at mum’s back.

Time passes and the student doctor comes back and asks a number of questions, most of which she has already answered and many of which she will be asked again. He’s Asian, and I can tell he is incredibly bright. His manner is impeccable and he is patient and respectful with the older woman who is sharing her medical history with him. Now that the pain is under control my mum is patient. More patient than usual. I guess she has no choice.

Another hour passes and the Orthopaedic surgeon returns. He asks more questions and calmly explains the results of last week’s scan and today’s X-rays. He wants to keep mum in hospital for a couple of days to manage the pain and do some more tests on what is causing the spinal pain. He’s young, with an English accent. He is professional and calm and gives a confident air of knowing what he’s talking about.

A senior ED nurse arrives and takes charge of organising to admit mum to the hospital’s Orthopaedic ward. She’s English too. Businesslike and efficient. Blood pressure. Blood tests. Form filling. More questions.

Finally an orderly shows up with a sense of humour and a happy go lucky attitude. He’s been here 19 years and knows every knock and cranny of the place. He gets us to the Orthopaedic ward without incident. There, a couple of amazing nurses take charge of my mum in an instant. She’s transferred to a proper bed, changed and finally ready for some rest.

There are lessons to be had from every experience, and although this day wasn’t planned, there is plenty to pick up from a day observing the health system in action.

Firstly, the medical staff are amazing. So much so that it’s not fair to single out a nurse over an orderly or a doctor. Despite the apparent chaos around them, they are all considerate, professional and helpful. Even the patients who shouldn’t be presenting themselves to an emergency department are treated with respect.

Many of the people whom I encountered had an accent. English, European, Asian and even an Aussie twang at one point. At a time when we’re constrained for resources, it highlights how much we have come to rely on overseas professionals plying their trade at our end of the world. They’re the very people we’re currently locking out.

I learned that the place is busy. This city has tripled in size in the last 30 years. And yet it is still the only hospital. It’s overwhelmed.

I learned that there is a lot of downtime. While I’m waiting I’m looking at my phone reading the news. There’s an article about the nurses going on strike. But the big story of the day is about the Government’s financial contribution to drug rehabilitation programmes run by the gangs for the gangs. I can’t help but consider the irony! There are better places for that money to go I think.

Although the people are amazing, the system that they are stuck in sucks. I can’t help but think that all these amazing medical people deserve some equally amazing systems and processes to help them become more efficient and to make their lives easier.

They need resources too. There aren’t enough of them. I would like to think that I know a bit about leading, managing and enhancing organisational performance. One day standing in a corner in an emergency department highlights opportunities for improvement at every step. Job number one: put the patient at the centre of everything you do.

As I stood there I considered the recent Government decision to centralise the management of the health services. That’s the opposite of what they should be doing. They should be localising rather than centralising.

Hats off to the doctors, nurses, orderlies and receptionists … the patient people.

But I hope I never get sick.

– Bruce Cotterill is a company director and adviser to business leaders. He is the author of the book, The Best Leaders Don’t Shout. www.brucecotterill.com

Tomorrow read Richard Prebble on why centralisation is not the answer to fixing our hospitals.

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