From a Patient’s Perspective

Many of you may remember David Clarke, our CEO from 1996 – 2002 (having previously been Chief Financial Officer from 1991 – 1993 and Chief Operating Officer from 1993 – 1996). Recently, David had a cycling accident which saw him admitted to Middlemore Hospital. Today I’ve asked him to share his observations about his time as a patient at our hospital.

Two months ago I had a road cycling accident while riding in a peloton in Clevedon. I came off my bike and landed on my face, and three of my riding “mates” then ran over me. Fortunately St John was on hand and quickly transferred me to Middlemore.

At this point I have to say that there’s no place I would rather have received care. I did try to get out of hospital as early as possible but that wasn’t a reflection on Middlemore, more that I wanted to get home as soon as I could (and of course minimize the costs for the DHB!). The service I received, during my five days at Middlemore and three outpatient appointments at Manukau SuperClinic, was fantastic and the whole experience was exceptionally positive.

Given my background, however, being admitted to hospital did give me lots of food for thought about what it means to be a patient and how our healthcare system works. My first few hours in the Emergency Department (ED) were pretty hazy but I do remember reflecting on the value of experience and senior expertise in healthcare. The St John staff who scraped me off the road thought I had a broken collarbone and hip, a diagnosis which was confirmed by the third doctor (a SMO) I saw in ED some two hours after arriving (much to the delight of the St John ladies). Even with all the x-rays, the first two doctors initially thought nothing was broken, then just the collarbone. The SMO and St John staff had considerable experience and expertise, the value of which became clear to me that day.

I received a highly professional service in ED before being admitted to a Plastics ward as an outlier (I was really an Orthopaedic patient). This worked well but highlighted to me the importance of continuity of care, particularly at what I call ‘boundaries’ such as transitions from one service to another. For example, I was taken to Radiology for an x-ray and left for about 2 hours. Overall, I spent five days in hospital, the equivalent of 15 hospital shifts. During that time I saw a lot of different nurses and took to memorizing my drug and therapy regimes so that I could explain them to each new staff member. The nurses were all incredibly professional and fantastic, but there is a challenge in ensuring continuity of care across shift changes or when a patient transfers from one service to another.

It’s not all the responsibility of clinical staff. Patients, too, need to take some responsibility for their care. I always suggest people monitor their medications when they go to hospital. No one goes to work to do a bad job but with the patient workload, work pressure and paper-based medication system, unintentional medication errors can happen. During my stay, I had a bad reaction to some of my medication and I made sure it was noted in my medical notes. I’d encourage other patients to help take a load off busy clinical staff by taking similar responsibility for their outcomes while in hospital.

During my stay I also saw patients complaining about the smallest details and I couldn’t help thinking ‘don’t sweat the small stuff!’. There are so many staff in hospital trying to do the best for their patients and occasionally someone gets the wrong breakfast (for the record this didn’t happen and the food was delicious). Don’t worry about it. The staff are dedicated, professional people working very hard who, I think, would respond well to respect and kindness from their patients.

All of this is very easy to say as someone who’s recently experienced the hospital system but you don’t really understand what happens in healthcare until you, or someone close to you, is involved. It’s not like buying something through the internet – the delivery of healthcare is a personalised, one-on-one practice. My lasting impression was that everyone was there for the same reason – to deliver high quality care to their patients. I’m just so grateful for the care I received and thank all the staff involved.

Thanks David. It’s really interesting to read observations from a patient with your background and there are definitely some things to think on. I’m really pleased to hear that your experience was exceptionally positive and that another patient was discharged having received the high quality care we pride ourselves on.

Geraint

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

6 thoughts on “From a Patient’s Perspective”

  1. Hi, was really great to read about David’s positive experience, just wondering if there would be an
    opportunity to video record his “patient story” , so it could be used for
    quality improvement training & staff education within CMDHB? Michelle Askew
    (Quality Improvement Facilitator)

  2. Actually Geraint I think David has made some insighful observations about his patient journey. He has raised a number of issues that we know is problematic- such as diagnosis complexity, patient placement (outlier status), and wait times for radiological procedure. Also, alarm bells surely go up when a patient tells us he had to memorise his drug and therapy regime so that he could explain to each staff member his medication regime. His comments in relation to patient workload, work pressure and paper-based medication system are reminders of how far we have to go. The responsible patient idea sounds good but there is a reasonable proportion of patients that come in that are not as well informed as David- or have intact cognition (either as a result of organic causes or drug induced etc). I think we need to see some real radical changes to improve out patient journeys- if this is the experience for a user who knows the system- I wonder what it is for someone who doesnt. Finally, it is always good to have our staff acknowledged in such postive terms- despite our challenging system- we still manage to get our patients through it!

    Good on you G for putting his story in…and it does so sound like his way of story telling…I think we need more real stories in.

    I was recently talking with one of our staff about a story in which the CEO would meet with staff who either had been in hospital or who had relatives who had been in hospital. The CEO would encourage the staff members to share their story and would use the stories to drive quality improvement. Maybe that is something you could try?

  3. I remember David and it is good to read his perspective. It contrasts starkly with comments made by Ann Clwyd Labour MP on the care received by her dying husband, and the subsequent article http://www.guardian.co.uk/commentisfree/2012/dec/05/nurses-have-not-stopped-caring and all the post article comments. It makes me relieved regarding the high standard of care given to patients at Middlemore, but worries me as my elderly parents are still in the UK. Fortunately their experiences so far in the NHS have been positive, but I’m still concerned regarding how the NHS is deteriorating.

    1. Thanks Diane. I also read that article and know very well the hospital the husband died in. You may be interested to know that it’s triggered a debate in the Welsh media about compassion in nursing which is, I think, an absolutely vital thing we need to retain.

      Geraint

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