A close encounter with a bench saw

Last week I talked about our values – wanting to embed our values of Together, valuing everyone, Excellent and Kind. This week I received, absolutely coincidentally, a letter from The Right Reverend John Bluck, retired Anglican Bishop of Taranaki, and previously Christchurch. This letter tells of his Middlemore experience, following a nasty accident with a drop saw while making a Christmas gift for one of his grandchildren. Rev Bluck’s honest account of his stay at Middlemore in the plastics ward under the care of Plastic Surgeon Murray Beagley, to me epitomises what we are trying to achieve and why I love this job so much.

If you want to put a hospital to the test, try making an emergency entrance on Christmas Day.

The place I literally dropped into could be forgiven for providing a cut-price service on a day when we should all be staying at home. But a close encounter with a bench saw had me whisked off to Middlemore in a rescue helicopter for three days of fancy hand surgery and equally impressive nursing care.

If any of this is a measure of the future of our public health system, under pressure though it surely is, then keep breathing; not easily, but confidently.

My last hospital visit was for tonsil removal as an 11 year old, so I was out of touch with medical and surgical procedures and standards. But the treatment I received seemed pretty good from people who were well-trained, confident and even funny at times.

I hadn’t expected to meet a helicopter paramedic in a Santa hat and a white beard (was it permanent?) or an anaesthetist with a waxed and curled moustache straight out of the Grand Budapest Hotel.

The mood set by these various medics was unfailingly upbeat and reassuring. We’ll find a way through this mess was the message I got, as much from their manner as their words.

And it’s the manner and tone of the experience that interests me most.

Here in this massive South Auckland hospital with a 1000 beds and 4700 staff, offering everything from a burns unit to neo natal care, the future of overcrowded Auckland and eventually New Zealand is being worked out.

Not just in medical terms, but culturally.

Middlemore looked to me from my hospital bed like a high stakes experiment in cross-cultural community building. High stakes, because hospitals are tricky places for getting very different cultures to work together.

The staff that cared for me over those three painful days came from India, the Philippines, China, Sri Lanka and Puerto Rica; there were Pacific Island and Maori, and the odd Pakeha or two, though mostly confined to the convoys of doctors who swept in and out on their daily rounds, moving at twice the speed and saying half as much as anyone else.

What fascinated me was the new social model emerging from this interaction of nationality, language, gender, class and skill. It’s being made to work at Middlemore, even on Christmas day. Here was a kind of diversity unfamiliar to most Kiwis, stretched to breaking point.

I can’t imagine how hard this diversity must be to plan and monitor, even when you understand each other’s language, and there are 105 different languages they can call on when needed at Middlemore.

But even harder to deal with are the hundred different cultural understandings of what is successful, efficient, acceptable, respectful. Setting up systems in a place this size to keep everyone safe and happy is space launch territory.

So visitors are limited to two a bedside, but the fine print says we’re willing to negotiate. You’re allowed to go home when the doctor says so, and no later than 11am, but it actually happens when the lady who has to sign off the paper work gets around to you, and that might be in five minutes or an hour or three.

I learnt that from a nurse who told me in a lowered voice, reluctant to contradict the official version.

And there are plenty of official versions of the way things should be. They reflect several different forces working to create this multicultural medical enterprise. HR meets PR meets OSH. Compliance and cultural safety have to hold hands. There is even a little room for religion. A well-displayed brochure promotes the Spiritual Centre complete with a Muslim Prayer Room, and offers chaplaincy services to people of all faiths and none. Less visible is anything Maori to help broker this cultural amalgam.

But the dominant theology preached here is the gospel of positivity; every day in every way we’re getting better and better. Messages of gratitude from ex patients abound on notice boards, describing the ward in language usually reserved for winning sports teams. “Ward 35N – you’re the best.”

You have to walk down the corridor to read that. The only message visible from my bed is a very large poster listing my patient rights to dignity, respect, support, information, proper standards and.. . The list rolls on and I’m grateful for the reassurance of the words, but I’m more impressed by the willingness of the staff to introduce themselves personally, to ask how I am, and to give frank answers to my questions.

A huge sea change has been washing through our public health system for a long time now.

Most of what I read about it is couched in terms of complaint, scarcity, overload and keeping chaos barely at bay.

What I didn’t know was happening was the birthing of a new work culture where people from hugely different backgrounds contribute, consult with, learn from and critique each other more robustly than anything I’ve ever seen before in New Zealand.

What’s being tried and tested in Middlemore today will shape the way we live and work together in Auckland tomorrow, and in years to come, all around the country.

Much of New Zealand outside Auckland sees the idea of multicultural nation like an early pregnancy. At Middlemore, the baby has already arrived, and is doing well.

John Bluck is a retired Anglican bishop and writer living in Pakiri

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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.

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