Climate Craziness of the week: Climate change as 'health threat'

suissebob
Thanks.
We try to fix it because it is not efficient.
It is, however, a totemic institution – vide the 2012 Olympic Opening Ceremony.
Much of the actual medical care is pretty good, but some of the bits around that are, sadly, CARP.
Mods – if not of relevance, please delete [and email suissebob, please]
Let me bore you. I had a stent inserted in January. On the NHS.
My ‘pre-op’ was before Xmas: here is the email I sent to the consultant [with certain identifiers removed, I am afraid …(very British)]: –
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Doctor B,
Thank you – and thanks to your team – for your efforts today; the practical medical side was excellent for me, and you and your team are an asset to the Hospital.
Very much appreciated!
As I indicated at the time, some other areas could repay constructive attention, and I very much appreciate your openness in asking for input from this patient, at least.
I am sure you do this with all your patients – and that should allow continuous improvement!
I would be certain of that, if the Hospital employs the Plan/Do/Check/Act methodology behind all the ISO management system standards.
To specifics.
The telephone system at the Hospital – especially the appointments/admissions line, on NNNN or NNNN – is utterly inadequate.
I phoned to confirm the appointment change, to today; after four attempts – immediately after returning from my appointment on 19th November ’14 – lasting perhaps twenty-five minutes, and being told the memories/message boxes are full – I gave up and simply turned up today as required [although my letter was dated 17.11.2014, the team member I saw on 19.11.2014 did not have it on my file].
Can’t some of this be emailed . . . . . . . . . .
Incidentally – hard copy files in2014?
Shipping, a profession at least as conservative as medicine, I guess, has been mostly paper-free, for me (now in my seventh decade), since about the turn of the century.
My City Heart Centre was not in the index for the map at the main reception. I know maps like that are expensive, but, as a document control issue , it seems a problem.
The invitation letter – the most recent in my file should be dated 17 November 2014, with reference M000636831 – is concise and clear.
I would suggest that you add, similarly concise and clear, wording to cover the following: –
•clear information about friends and relatives being kindly asked to leave after seeing patients to the unit. Much upset today on this. As everyday??
•add a query about Blood group [if this relevant]
•adding something about hydration – ‘take an extra glass of water the night before and another before 0600 on the day of admission’, say, but your words; you want blood vessels to be easy to find.
•explain the questionnaire on admission – the information is required for medical purposes; it will be checked periodically whilst admitted [especially allergies, diabetes, previous history & c.]; and can be completed on-line before admission [maybe – if your IT’s Name Surname, who I worked with some years ago, can/is allowed to do it] – or at least download at this link, complete and bring in [that will save you, the Hospital, printing costs].
•If the letter is a change of appointment, please make that clear. To save further, if it is indeed a change of appointment, do not send (again) the important leaflet ‘your angiogram/angioplasty’ – merely ask the patient to keep the one in the first letter (or request one at the pre assessment clinic).
1.Incidentally, does each Trust draft their own leaflet for phlebotomy, angioplasty, adenoid removal, cataracts, ingrowing toenails and the rest? Cannot items like this be sourced centrally; routinely updated with best practice,; referenced with a link in the invitation letter, and the patient asked to confirm, perhaps in the questionnaire, that they have read the online leaflet. If they have questions, they should be noted and covered at the pre assessment clinic.
2.This would apply, too, to admission/invitation letters, and – you know far better than I – perhaps other routine, standardisable documents issued in their millions, nationwide, each week . . .
3.If adding much of this, do print letters, & c., double-sided.
I am entirely happy that the Hospital agrees with its staff their hours of work. But if client-facing staff have a start-time after 0800, it may be worth considering whether asking patients to arrive at 0800 [and today, all five who attended were there by 0755] should be reviewed. Perhaps, as you suggested, 0815 for patients (given the traffic, it won’t make much difference to us/them].
*** That the electronically-controlled doors were released at about 0750 is nice – but is, also, a security breach.
I would treat it as such on my ships.
Does the Hospital have a ‘flagging’ or ‘Near Miss’ or ‘Hazardous Event’ or ‘Opportunity for Improvement’ system?
If so, perhaps you could raise this event as a ‘Near Miss’, or even a ‘Security Incident’?
On arrival, can the Hospital not handle patients arriving at staggered times? [2 @ur momisugly 0815, 2 @ur momisugly 0900, and 2 @ur momisugly 0945, say?]; some patients were ready for procedures by 0930, yet spent 90 to 120 minutes waiting.
I emphasise the need to explain the need to double check some items on the questionnaire. To pick up the questionnaire, then ask several questions, risks looking unprofessional – without being very clear that these are, actually, important queries – and confirmations – that affect the patient’s treatment, and must be confirmed as best practice, even if most or all of the answers are in the document being held in the questioner’s hand.
To then immediately take a BP reading compounds the perceived difficulty (even insensitivity)!
Do your staff think that one amlodipine tablet and a ramipril capsule will miraculously reduce ‘BP’ by 30% in a couple of hours?
Compared with, say, explaining what is happening . . . . .
Do listen to the answers given by patients; one gentleman had been given a pencil to complete the questionnaire [‘no pen’ – my guess, “the cuts”!?!], explained that there had been no pen [no request to carry a pen is in the appointment letter] – but was made to listen to a repeated instruction for it to be inked, not pencilled, in.
After the procedure, whilst waiting for – well, I knew only after about 90 minutes waiting, no earlier: why was there no simple explanation? If my delayed update was because I had asked questions earlier, I understand.
The bolshie bu88er must learn his place.
Not ideal as a model of client care, but very human.
If, however, it is systemic, I suggest that you and your team collectively, need to investigate . . . .
Remember patients, generally, have very little experience of the processes of a hospital.
[and possibly ask staff to explain TLAs, etc.]
My wife completed a ‘complaints form’ (Complaints, comments & congratulations form) – a glossy brochure. Could that not be a simple (cheap) black & white form, possibly on line . . . .
I’m sure you have noted, too, that most of the above items are provider comfort, not patient information/understanding/convenience.
That is cultural; necessary culture change (I know!) takes years to work through even a modest shipping company.
The NHS, I hazard, may take a decade.
Yes – how do you eat an elephant? One bite at a time.
Old QA maxim from the 1990s (at least).
Finally (yes, you made it! – and thanks!):
Do get fire door FD 89c/0/19/32 looked at. It closes, but noisily, and very slowly [twenty to thirty seconds – is that fast enough??].
Doctor B, I would appreciate an acknowledgement, only, to both email addresses.
Unless your system requires it [not optional, but actually required in black and white (and if it does – require – this, do, please seek to change it!) it is utterly unnecessary for individuals; MPs, government bodies, possibly . . . but NOT, absolutely not, individuals], there is absolutely no need on my side for you to respond in detail, let alone update me monthly on progress!
You, your team, the Hospital and the NHS have many much more important tasks to handle.
Thank you for your openness and patience with this email; I have tried to be constructive throughout, but I am human. If you need to redact some phrases before passing on within the Hospital please do so.
And again, thanks for today.
Best regards,
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Sorry – you asked . . . .
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