Most of all, don’t leave the room, so you don’t miss the doctor

Anna Sant

"A much closed organization, where information doesn't flow. While you are in the hospital, you live in an environment where nobody wants to have the responsibility of communicating with you. They place this responsibility on the patient: if you have any problem, ring the bell and someone will turn up. Meanwhile, just stay here. And, above all, don't move, so you don’t miss the doctor. "

This is the story that a relative told me two weeks ago when he explained his recent hospital stay after thirty years without stepping foot in any. He added: "You realize that you are in their hands (surely good hands, I have nothing to complain about), but nothing is expected of you as a patient." And he explicitly repeated: "One more thing: don't get out of the room, so you don’t miss the doctor..."

This is, unfortunately, a common situation in many hospitalization plants. The patient becomes the only static element in a room where there are a lot of busy professionals who don’t communicate well with each other. As the patient is still, paradoxically, he becomes the meeting point and the final transmitter of information that is not necessarily accurate or complete.

Assistance Fragmentation in the Hospitalization Floors

"The hospital is a clue game," adds my mystery patient. "The nurse wants to give me information, but the one who has to do it’s the doctor. The doctor will come, but we don't know what time and when he finally turns up, he tries to explain things in just over two minutes. Thus, ultimately I am the one who ends up informing the nurse that they will perform a test and I have to be fasting. She doesn't know anything but assures me that she will check the information in the system. Later, the assistant brings breakfast, but I inform her that I have to have an empty stomach. Surprise, she assures me that she is going to check with the nurse. Then a health assistant arrives and takes me to take the radiology test. At the radiology room, the administrative checks her papers and notes that she has no test request so they take me back my room. The nurse, who was looking after me, tells me that after talking with the doctor, they finally decided to take the test tomorrow. There has been a misunderstanding. After all this, it's been three hours and I haven't had breakfast. There is no breakfast service anymore, but I can have a yoghurt and a cookie."

In addition to the inherent risk that information fragmentation can pose for clinical quality and safety, it also causes a significant loss of time spent solving errors and misunderstandings. This entire problem is the inheritance of a still very hierarchical hospital structure that separates the different professional profiles from each other. Doctors, technicians, nurses, assistants, social and administrative workers depend on different departments or managements, have different working conditions and schedules and, often, work according to methodologies that have different objectives. Surely, the tasks of the hospitalization plant would flow more effectively and efficiently if we worked on consistent clinical micro-systems, in groups of technically trained professionals who share values and they know how to collaborate to achieve desired goals.

Teamwork and Clinical Communication Techniques

Even if it’s very important that basic aspects that would facilitate the lives of professionals, such as better shift management, workload balance, more resources, leadership training and change management, etc., are resolved, we need to simultaneously put in practice tools, protocols and techniques of clinical communication.

The objective is the improvement of coordination between professionals and the focus on the patient’s needs when hospitalized, not only his health but also his psychological and social needs. If we could work more towards self-management and the empowerment of clinical teams, perhaps my family member could have had a very different experience.

"I am very informed of what is happening to me, what they will do to me from now on and what are the objectives of my treatment because I have been visited by a multidisciplinary team of professionals who have reviewed my case in my presence and I have been able to answer questions; I also know that the afternoon nurse is informed of the pain I have had today and the change in the medication schedule because I have witnessed the change of nursing shift.

I am calm because every two hours a nurse or assistant goes around my room to see if everything is fine, especially with regards to my pain, position and my needs to go to the bathroom. Also, I perfectly distinguish the nurses from the auxiliaries because when they arrived they showed up and explained how each one could help me.

Every time a new professional treats me, he reviews with me the key elements of my treatment. In fact, in my room, there is a board with information agreed by the team about my clinical plan, the new medications, the tests that I have to practice and my health goals and expectations. The latter, thanks to the fact that when I entered I was asked what were the three things that would best describe, in my opinion, good care and hospital stay. Today the plant supervisor has passed to ask me how they were taking care of me and to know if he could do something to improve my hospital stay."

In short, we must look for meeting spaces for debate, teamwork and, above all, tools to systematize and better share information. We have to make the hospital "a place where information flows and everyone wants to have the luxury and opportunity to communicate with the patient."