The ‘chaos’ at Heathrow this week has graphically illustrated just how difficult implementing large-scale change is. As is usually the case, it is not the kit that fails to work, but rather the human factors that can’t or won’t cope.
In a similar way, the NHS possesses great technical expertise and adequate kit (most of the time), but the experience of the patient, the final consumer of the service, is often woeful.
And yet, the essential quality that patients (and staff) are looking for is kindness. It costs little to be kind but we find it so hard to do. We find a hundred-and-one reasons why we can’t be kind, or worse, we deny that it’s a problem. But every day in the NHS, I come across shameful acts of unkindness and lost opportunities to positively be kind. At the same time, we want to be kind. That’s why we chose to work in healthcare, isn’t it?
So, my revolutionary idea to fix the problem is to train kindness. Because we assume that everyone is, or can be, instinctively kind, we feel it is unnecessary, or even frankly patronising, to systematise kindness. However, we can all think of instances when we have been delighted by someone’s kindness, and that should be reproducible and amenable to being taught. In many service industries this is already done. It’s usually called something like ‘customer contact skills training’, but basically it is the deliberate training of staff to be kind to consumers. It would also revolutionise the way colleagues interact.
What’s stopping us doing it?
The child’s mother said, “Have you seen that new film about being awake when you’re having an operation?” “Er, no. (Pause). Was it any good?” I asked hopefully.
I was just about to ‘induce’ (put to sleep) her six-year old, who was eyeing me with suspicion. I had visited the mother and child just before the start of the session and my usual consultation had not elicited any discussion of awareness under anaesthesia (that’s what we anaesthetists call being awake during surgery, when you’re not supposed to be).
Happily, the surgery passed off with nothing untoward and mother and child were soon re-united.
However, the incident highlighted a couple of points:
- Patients don’t always voice their concerns at convenient moments
- Communication of risk information is difficult, but important
- Awareness under anaesthesia is terrifying and real
- Always chose a local or regional anaesthetic technique if available
- Err on the side of giving a bit more anaesthetic than not enough with paralysed patients. Why sail close to the wind?
I am now back, full-time, in the operating theatre (albeit on a short-term contract).
The operating theatre is a self-contained, ‘little oasis’, of intense medicine. The work is highly-focused, on one patient at a time, and there are few disturbances once the work is underway. I guess it must be a bit like the experience of a flight crew once airborne.
The feeling is highly pleasurable. You are ‘in control’ of your own little world and all your attention can be devoted to the operation. In anaesthesia, the best anaesthetics are seemingly boring ones; no-one wants an exciting ‘flight’! Of course, there are sometimes moments of extreme stress (like flying too) but as experience increases, these are few and far between. When they do occur, your training helps you cope with most contingencies.
To mix my metaphors, you can think of the anaesthetist as a chef. You take combinations of drugs and techniques and develop them in a way that produces the best effect for the patient and surgeon. This is very creative and satisfying. A physiologically stable, pain and nausea-free patient is a powerful, positive reinforcement for any anaesthetist!
The final shot-in-the-arm is the gratitude and pleasure expressed by the nurses in the post-anaesthetic care unit and on the wards. They see the direct results of your ability and a wise anaesthetist will value their feedback. If they are strangely quiet and reticent when you appear, ask what you’re doing wrong.