Tuesday, 3 May 2011

Hospitals and Family Care

This year, I've had more to do with hospitals than I have ever done previously. This is not because of any needs that I personally have, but rather the needs of my family. In visiting two hospitals in particular, I was struck by the issues of design and care.

There is often a battle here between idealism and reality. It can be said that idealism costs money, and reality is the cheaper option. This need not always be the case though, as creative thinking and planning can have a major impact on good design.

The question to ask is "what is a hospital's primary purpose?". Surely the answer is "to make patients' better in as short a time as possible". Design and care should both focus on this primary purpose. Are they both helpful towards this end, or do they present barriers to it being achieved?

Much has been written over the years about hospital design, but how many have been listening? Modern hospital buildings are designed to minimise the effort of medical staff and the possibility of contamination, while maximising the efficiency of the whole system. However, it has been said that many hospitals, even those considered to be 'modern', are the product of continual and often badly managed growth over decades or even centuries, with new sections added on as needs and finances dictate. One such critic is the Dutch architectural historian Cor Wagenaar who called many hospitals;

"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety".

Research by the British Medical Association is showing that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression. Single sex accommodation help ensure that everyone is treated in privacy with the dignity they deserve. Exposure to nature and hospital gardens is also important - looking out of windows improves patient's mood, reduces blood pressure and stress level. Eliminating long corridors can reduce nurses' fatigue and stress. Newer hospitals are looking at moving away from a ward-based system to accommodation in single rooms. Whether this will ever become the norm for 'non-payers' is anyones guess, because of the cost of the design.

I have to admit to finding it funny, that these 'new' ideas have in fact been around in various forms for a very long time. Examples are: William Penn in late 17th Century Philadelphia, founded the first Quaker hospital with revolutionary attitudes to care. Florence Nightingale in the Crimean War of the 1850's and for years afterwards changed the face of care. Equally revolutionary was the Royal Naval Hospital, Plymouth in the late 18th Century. We are learning, but I think that we need to learn a bit quicker.

It might be good to dream of a near perfect world, but we inhabit this current one. It may have it's imperfections, but these can be overcome somewhat, by the quality of care given to patients. So how have my family got on?

Addenbrooke's Hospital
In January of this year, my Son contracted the rare neurological condition, Miller Fisher Syndrome which left him blind and unable to walk for a few days. He has spoken of this on his own Blog at http://www.canningcircus.blogspot.com/ He has only just started to return to work part time.

I was glad that he lives in Cambridge, and so found himself at the world renowned Addenbrooke's Hospital, with the best doctor's available to diagnose, and treat his condition.

Because of this expertise, the diagnosis was fairly quick, and treatment could begin early. He had five days of intravenous drug treatment, which was expensive, but given without hesitation. This may not have been the case at another hospital trust, who may have preferred to look for the body self-healing, even if that took over a year. Thankfully he was in the right place to get the best care, and from a non-patient perspective, I believe that he had the best care.

Good Hope Hospital
My Sister was diagnosed with lung cancer in March of this year. After three biopsy's - the first two were inconclusive as to which type of cell cancer it was - a decision was taken as to what treatment she should have.

By this time she'd already seen a number of people within the medical profession, and now it was time for the first meeting with the Oncologist. Her hospital was to be the Good Hope Hospital in Sutton Coldfield. I went with her to that appointment. The Oncologist was warm and friendly; took time to explain everything in detail, and made sure that we understood everything before we left. This was also true of the cancer nurse we saw before leaving the hospital.

My Sister had her first Chemotherapy session last week, with at least three, and possibly five more to come. The hospital room where this took place was quite large, with comfortable chairs around all the walls. Though having to be there for nine hours of treatment, and with the room being exceptionally busy and noisy (due in part to them having the Royal Wedding on the TV), the nursing staff couldn't have been more helpful and friendly. Though some of them were on 10 hour shifts, I've no idea when any of them took a break, and their enthusiasm and helpfullness never wavered. They carefully and sympathetically took time to explain to by Sister all about the medication that she needed to be taking, when and why. These are my observations you understand, not hers.

An article on hospital care admitted, "One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff, which dehumanises the patient and prevents more effective care as doctors and nurses rarely are intimately familiar with the patient. The high working pressures often put on staff exacerbate rushed and impersonal treatment".

We want your views

In an organisation as large and complex as the NHS, it's inevitable that there will be a range of views on the type of care people receive. I have read what feels like hundreds of comments from patients and families of their experiences of Addenbrooke's and Good Hope Hospital. Satisfaction rates can vary between departments, and at times within the same department. Often this can be 'personality based', as it depends on which doctor or nurse you see. Any business has a problem if customer satisfaction is based on personality rather than policy.

Patient comments can be found on every hospital through the NHS Choices User Ratings. One of a number of questions available is, "Would you recommend this hospital to a friend?". At Addenbrooke's Hospital, the overall rating was 76% for yes. At Good Hope Hospital the overall rating was 50%. The first rating I think is quite acceptable, while the second one could do with improving. There may be many reasons why 24% of comments at Addenbrooke's said no, and why 50% at Good Hope said no. Everything may not always be down to the hospital. Sometimes patients and families can have expectations that cannot be fulfilled, but are understandable when you are very concerned about yourself or your loved one.

My Son and Sister can speak for themselves, but so far, in my view, I cannot complain about the care and treatment that they have received. I believe that a lot of this satisfaction is down to two very simple words. Communication and explanation. My family has gone through, and is still going through worrying times. The unknown brings fear and worry. Your mind races in all directions, and you cannot be at peace. To know that someone is talking to you, and talking you through your illness is a great relief, and surely that must have some impact on your ability to recover.

Some may feel that the NHS has failed them, but for me, as someone outside, looking in on the care of family, the NHS deserves praise. By NHS here, I of course do not refer to a monolithic structure, but to the men and women who work on a one-to-one basis with people in need.

1 comment:

  1. Dad - just wanted to support what you've said here. Addenbrookes was simply amazing - their liver and onions left a little to be desired but their medical expertise was exceptional - I'm glad it was that way round.