Lessons from medics through the eyes of a patient

It was around 18h00 when I received the call from my General Practitioner.

Because he has been the “Captain of my Medical Ship” for a long time, I sensed some urgency in his voice when he told me my heart enzyme is significantly raised and I need to report to the emergency intake of the closest hospital with a cardiac unit. Although it followed two days of tests after experiencing a shortness of breath and dizziness I was not prepared for this. However, after another two days of enjoying private care, I am fine and able to reflect on the excellence I experienced. Indeed a privilege!

Emergency intake is like a train station. People come in and need to be “shipped”. Understandably a person who just walks in would create some confusion. However, I was ably assisted and taken up after which my medical report was checked and new blood tests requested by the Trauma Doctor. It is at this point that my first realisation of the quality, organisation, and coordination started to surface. For me, the first learning point was the availability of facilities, equipment, and resources. The Resident Pathologists came over to my bed and took blood samples, it was not long before the tests came back and I was moved to the resuscitation room, with an adequate explanation of the reason. Here each bed was attended by a qualified Nursing Sister and the facility had what I gathered would be a qualified Medical Technologist. In all instances, they introduced themselves, stated their role and encouraged me to ask questions. From an organisation perspective, it reminded me of a client, Namibian, who was privileged to have spent time with some of the great organisation psychology and management gurus of our time. His words were “if you want to be world class, everything should be” from the toilet to the boardroom. And this is what I saw, huge capital investment, reflected in everything from the blood samples to the scanner that checked whether I could possibly have a blood clot in my lungs.

From there I was admitted to the general cardiac ward and again very ably assisted by qualified and committed staff. An interesting thing happened though. While moving me it was gently pointed out that I need to keep myself covered with a blanket, not only for comfort but also because it is a policy for reasons of privacy. Again I was reminded of the habit of a client who used to inspect his facility. Even the smallest of deviations were noted, not to go on a witch hunt or being vindictive. But the philosophy was that these deviations are indicators of a deeper issue that need to be uncovered, assessed and corrected. This practice is very similar to that of organisations who score high on the Malcolm Baldrige National Quality Award (MBNQA) in the US.

The next morning came and as usual, the operations in the ward were clearly efficient. Again and on reflection, more learning points came to the fore. All my transitions from one facility to another were smooth, no confusion. A short briefing and I was settled. In addition, I noticed that certain situations triggered a very standardised response. For example, I was on oxygen. The water container ( I assume a type of humidifier) is checked at standard intervals. When a patient is moved out of the ward there is a standard protocol (blankets off, wash the bed, wash the area around the bed, then new blankets on). What became clear is that the processes, procedures, and protocols are deeply (and I repeat deeply) embedded into the operation. But it is in the minds of the people. The technology to support them is in place and with this kind of operation, all these are documented. But the essence is that the people “own” these, and getting them to is a leadership function.

During the mid-morning, I was visited by another (upon further discussion I realised a graduate) Nursing Sister from the offices of the attending Cardiologist. She briefly enquired about my welfare and asked to describe the events that lead to me being admitted (this practice seems to be standard and in no way an indication of confusion or lack of information). She then proceeded to explain to me what the next steps are and recorded these on her tablet computer. This person would become my coordinator, source of information and support throughout (even as I am sitting here and writing this note). I sense that when you become this specialised roles can evolve, where you don’t just perform you classical duties. Your contribution is much wider, across functional boundaries (in this case a supporting, project coordination role).

My procedure would start around 19h00 of the second day. The facility is obviously state of the art (something like the Starship Enterprise), where all involved work, plan, work again. Although (as I understand it) the angiogram and the actual procedure took longer than normal I was fully conscious throughout. Both the Attending Medical Specialists gave me information, were supportive and at no point, I felt anxious or worried. At the end of the procedure, I quickly enquired from the Medical Technologist what her background is and was again impressed by the depth of experience (this individual from my observation is a vital link in the completion of the procedure).

I was finally “shipped” to ICU for the rest of the night. During the evening I saw what was clearly the Lead Nursing Sister doing a type of training with the other Sisters and Staff. In addition Nursing Sisters coaching each other (maybe for a re-examination) on medical issues.

In all a wonderful albeit scary experience. In saying goodbye to my ICU Nursing Sister and the Sister who coordinates my rehabilitation, I realised that all the people here are engaged (motivated by their purpose, the clarity in this regard, and understanding of how they fit and also in terms of the way they are recognised and rewarded). This makes me think of the mission of the Ritz Carlton “We are Ladies and Gentleman Serving Ladies and Gentleman”. The Ritz is a Malcolm Baldrige National Quality Award recipient. But in the book that describes the service standard of this Hotel Group the author is clear. It is the leaders who determine the psychological climate and this permeates through everything and specifically the culture.

Management Guru Edgar Shein states that organisation culture manifest “in the way things are done here”. My main artery was successfully opened by the way things are done at this facility. I am thankful and blessed.

Postscript for specific detractors:

1. For the conservatives:

This facility is sufficiently staffed with people who represent the diversity of South Africa. I did not experience any deviation in terms of service and support; neither in the way, people interact with each other or are being treated.

2. For what Graham Hancock (in his Book the Lords of Poverty) refers to as “the development set”:

They usually say that this is South Africa, a developing country. To them, I say yes the context determines the leadership approach. This is a very specialised hospital and the investment is huge. In addition, they have the financial resources to attract the best. However, one good leader (influencer) make more and that can change a culture. Training, institutionalising and monitoring standards and treating staff well is relatively inexpensive.

In addition, by saving on waste, massive corruption and theft many more facilities can be established with a bespoke level of care. There are already some but far less than required.

I know I am enormously privileged, notwithstanding the fact that my “cashbox” is completely empty. Nevertheless, to the development set, I would say (quoting from Hancock again) be careful that you do not discuss malnutrition over steaks and plan hunger talks during coffee breaks.

Philip de Kock is a Change Management Consultant, https://dkockpm.wixsite.com/the-coachinglab.

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