We claim to be committed to team working but hierarchies and tribal type loyalties often take precedence over genuine team approaches to meeting the needs of patients, writes Denis Doherty.
I was taken aback recently to hear a Clinical Director of one of our major hospitals use the term professions supplementary to medicine in an interview on national radio. I had assumed the term had been consigned to the dustbin of history. But, I was wrong. When in vogue, it was a term more used in the NHS than here where para- medical grades was the expression more often used. Both terms were used as a way of lumping together the newer professions and, at best, could be considered clumsy in that they implied less than full membership of the family of health professionals. The reality is that these professions attract very talented young people, mostly women, who perform vitally important roles in increasingly complex work environments. The Clinical Director was being complementary to colleagues when using the term professions supplementary to medicine and clearly no offence was intended but, the risk of offence being taken could have been avoided by referring to them as colleagues in whatever health professions he had in mind.
For more than thirty years, John Hume advocated ‘parity of esteem, respect for diversity and the spilling of sweat instead of blood’ as important in resolving the conflict in Northern Ireland. It took that long to achieve the progress that resulted in the Belfast Agreement. Health services here and in the UK are perhaps just as resistant to change as Northern Ireland was.
Teams consisting of talented individuals performing in whatever fashion they themselves consider worthy of their talents are not in the best interests of patients.
We claim to be committed to team working but hierarchies and tribal type loyalties often take precedence over genuine team approaches to meeting the needs of patients. Services are still organised in silos that too often function independently of each other. That is not in the best interests of patients. Teams consisting of talented individuals performing in whatever fashion they themselves consider worthy of their talents are not in the best interests of patients either. It is hardly surprising then that patients come away with a sense that their stay in hospital could have been better planned, better coordinated and more efficient. Their experience is often one of their having to conform to how the hospital functions rather than of the hospital being adaptable to meeting their needs.
At a minimum, patients are entitled to be assured they will not be exposed to avoidable risk while in hospital. When visiting hospitals now, we encounter, in prominent positions, facilities for cleaning our hands and are made aware of the importance of strict observance of the advice regarding their use. People cannot understand then why not all staff observe the recommended hand hygiene practices. They expect every member of every team to observe recommended practices and they expect zero tolerance of non-compliance. They are incredulous when they learn that many members of staff who work directly with patients most vulnerable to hospital-acquired infections often breach the standards expected of them. The fact that doctors have been shown to be often non compliant creates confidence and credibility issues. The medical profession, which espouses evidence-based practice, is expected to show leadership in protecting patients from avoidable risk and is seen to be failing to do that. Members of the public form judgments more on the evidence before them than on proclamations of commitment that is not borne out by the evidence before them.
The fact that doctors have been shown to be often non compliant creates confidence and credibility issues.
How often have investigations into failures that resulted in serious consequences for patients ended up in the cul de sac signposted ‘system failure’?
System failures do, of course, occur but, in many cases, it ought to be obvious that the design of the particular system leaves it prone to system failure. In other situations, failure to adequately resource the operation of the system or to adequately train the operators of the system may result in failure.
Experience tells us that even where well-designed and resourced systems are in place serious incidents sometimes occur and, that ‘pilot error’ is frequently the cause. Effective teams are a first requirement in complex work environments, such as healthcare, and high performing teams are essential to consistently perform to best practice standards. High performing teams are made up of talented, well-qualified individuals, who understand the role they are expected to perform and who also understand the roles that others play. They respect and support each other, especially when things don’t go according to plan. They also feel empowered to challenge the performance of their team when basic standards are not being met. A commitment to respecting diversity, affording parity of esteem and agreeing to spill our sweat not our blood, metaphorically speaking, is a good starting point.