I am very cognizance of the fact that we live under a constant daily digital deluge of data and opinions. Why on earth would I want to add to this noise? Do I have anything to add? Perhaps not but you will be the judge of that…
I would like to start by espousing the principles that I try and enact in my daily practice as a heart surgeon in Leeds.
Firstly, work is a social construct. It is people working with people and in all systems this is dependent on relationships and perceptions of all the people working in that system. Since ninety five percent of communication is non-verbal, it is always better to meet and chat. The NHS is the people and the service is dependent on these people at every level.
Secondly, it is very difficult as an individual to carry out any work without any input or help from anybody else. We are all dependent on someone for something and someone is dependent on us. Seldom can we do it alone. I know, as a heart surgeon, that my skills are rendered inadequate unless I am supported by a team of at least ten people and that is in theatre alone. I am reminded of when I had a problem with the pacing box; I decided to take it to medical physics to explain the problem and understand their quality control systems. It transpired that I was the first surgeon ever to visit their department and the head of that department was much attuned to the workings of a pacemaker because his mother had recently been fitted with one. It is very easy to get things done when we take trouble and time to meet face-to-face with people on whom we are dependent and get to know them at the very least by their first name. During my training years, I was the Director and /Producer of the Christmas shows. Anybody and everybody in the hospital were invited to participate. It never ceases to amaze me the talent that can be found in an organisation such as a hospital. We had lots of fun but more importantly we got to know each other well. It made the walks along the corridors of the hospital more interesting as I passed friendly, familiar faces- many of these friendships have lasted more than 20 years. I walked into the hospital one morning and a porter, checking blood out of transfusion, greeted me with a cheery hello and I mumbled back. He did not hear and repeated his hello. I apologised and said “thank you” and returned his greeting in kind. Previously, I was impressed that the Director of Quality at Beth Israel Hospital in Boston greeted the cleaner of the corridor by her first name as he led me to another office and I am reminded of the past Director of Operations who said that his role was to help patients, despite the fact he did not have the privilege of direct patient care. This is the meaning of the ‘I am here to put a man on the moon’ reply that a cleaner at NASA gave JFK. This is the socialisation of work – the meet and greet of every day and the sharing of values. In general, we are poor in our conduct of this simple courtesy and acknowledgement. Moreover, we are missing the swapping of stories in the corridors and necessary knowledge exchange. It is no wonder that the recently opened Costa Coffee in the hospital has become a hub of activity.
Thirdly, everybody is an expert. The best person who knows how to clean the floors is the cleaner but do we ask them how best they think the job should be done? This is true of everyone in the organisation and the source of most discontent. Hospitals are very complex organisations as acknowledged by the editor of Harvard Business Review. The solutions however, are often simple if we take the time to ask and listen to the reply. I introduced a “fit to admit clinic” that was lauded by all except the outpatient clerk who noticed that patients were waiting longer and felt it was not efficient. I asked Angela to redesign the timetable for the clinic as she felt appropriate patients because I was seeing patients in the examination room oblivious to the waiting and I am certainly not the expert.
We are in the process of renovating our house. I marvel at the skills of the builders, joiners, electricians, plumbers, tilers and painters – it took me three days to gloss a window sill and even then I had to redo it after searching Google for ‘how best to gloss’!. I am more worried about taking a drill through the wall in my house than I am using a sternotomy saw.
In essence we are in a people business and we are dependent on people and people are dependent on us. Take time to say “hello” – you may discover that Joy, the junior nurse in theatre, yesterday enjoys ice climbing!
DAVID J O’REGAN