Not disagreeing with any of that, but why is it ridiculous for such an organisation to seek internal feedback or look to highlight examples of good service/ performance? Why can't such a mechanism form part of an overall feedback/assessment model? Those inside the system are best placed to identify smaller pockets of high performing individuals or teams. To say that any such feedback is ridiculous does nothing to encourage rising standards.
Why go to A@E with flue
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Some of my colleagues worked in A&E as reception/clerical people. During the daylight hours the environment is difficult enough in which to work, but come the night and especially weekend nights nobody knows what's ahead in the next hour never mind the whole night. Our Gardaí will deliver any case they see fit. They are not going to lock some drunk/drug abuser into a Garda Cell just to spend the night. If anything untoward happens the Garda is left out on a limb, so he/she will bring the person to A&E. This will happen several times per night nearly every night. Many of these patients "come around" during the night an walk out (forget about even discharging themselves). Usually, they do not supply information of even who they are or where they live (probably in fear of receiving a bill). It is not unusual for some of these people to become aggressive and threatening during the night also.
Many people see themselves as the most deserving cases and insist on jumping the queue. Also, you have plenty of the public advising why their people should be seen first and even object to any length of time on a trolley. Doctors, nurses, clerical staff get fed up with the phrase "I'm a taxpayer . . ." Some of these people think a hospital trolley is a wheelbarrow. You will be contacted by political peole during the day and night also to be seen representing their constituents. These guys don't care what they say or what rank they pull just to ensure the patient hears that his political representative is dropping everything for patient welfare.
No two nights are the same. Flu outbreaks, big sports events, festivals, holiday periods, weather, ice, etc can influence immediate huge increases in demand of the service. We can all shout about the service. Internally, the staff shouts about the service too. We need a whole change of mindset regarding minor medical care and until some sort of power is released to nurses to write prescriptions or pharmacists to advise and dispense drugs accordingly we might as well be sneezing against the wind and our Accident & Emergency facilities will continue to be overcrowded.
Many people see themselves as the most deserving cases and insist on jumping the queue. Also, you have plenty of the public advising why their people should be seen first and even object to any length of time on a trolley. Doctors, nurses, clerical staff get fed up with the phrase "I'm a taxpayer . . ." Some of these people think a hospital trolley is a wheelbarrow. You will be contacted by political peole during the day and night also to be seen representing their constituents. These guys don't care what they say or what rank they pull just to ensure the patient hears that his political representative is dropping everything for patient welfare.
No two nights are the same. Flu outbreaks, big sports events, festivals, holiday periods, weather, ice, etc can influence immediate huge increases in demand of the service. We can all shout about the service. Internally, the staff shouts about the service too. We need a whole change of mindset regarding minor medical care and until some sort of power is released to nurses to write prescriptions or pharmacists to advise and dispense drugs accordingly we might as well be sneezing against the wind and our Accident & Emergency facilities will continue to be overcrowded.
Sophrosyne
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Leper,
I think you are on the right track, not just in relation to A & Es but also to hospital clinics.
An acquaintance of mine read your posts and very kindly let me reproduce an email she sent to Mary Harney, Health Minister in April 2006, to which she did not receive the courtesy of a reply.
"Dear Minister,
Some years ago, I developed a thyroid problem.
I was referred to a consultant who unfortunately died.
Until I could be referred privately to another consultant, I had to attend a public hospital clinic.
I made maybe 6 or 7 visits to this clinic. The waiting time to see a doctor was usually 3 hours plus. On one of the visits it was over 5 hours. On each occasion the consultation with the doctor (I never actually saw a consultant) lasted less than 10 minutes.
Before each visit, I had to have a blood test, which was looked at during the consultation.
Apart from the first visit, when my thyroid was examined, the only matter considered during the consultation was my blood test. My physical presence during the consultation seemed unimportant. In fact, on two occasions, the doctor had no idea who I was, my medical history or my personal status.
The result of the consultation was to either increase or reduce my medication dosage.
During each of my visits to the clinic, there were in excess of 100 other patients who all appeared to have appointments at the same time as mine.
Most of the patients I spoke to said that my experience was the norm - queue for hours, see usually a junior doctor for a few minutes, who will tweak around with medication dosages and tell you to come back in 6 weeks.
What I could not understand during my experience with public clinics was that if the only thing that mattered was my blood test, why did I need to be there. Through travelling to and from the hospital and the unreasonable queue time I was absent from work for 5 to 6 hours per day.
There seems to be two problems,
- Firstly, the lack of adequate consultants in public clinics is false economy. I was later referred privately to a consultant, who cured my thyroid problems after two visits. Had this not happened, I would probably still be attending the public clinic and my thyroid problem would at this stage be extremely serious. The appointment system is obviously not working. It is not possible for anyone to treat more than 100 people all at once. Naturally, the most serious cases will be prioritized. But this allows others, like myself, who could be cured if proper attention was given early on, to become progressively worse.
- Secondly, is it necessary, in this day and age, to force people to queue for hours in the dismal surroundings of a public clinic, many of whom have to bring their children with them. If it is simply to examine a patient's blood, surely this does not always require the presence of the patient. Where I live there are umpteen, clean and pleasant pharmacies who if provided with competent nurses, could have taken my blood and sent it to the hospital for examination. If the dosage needed to be amended the hospital could telephone or mail me or arrange an appointment if they needed to see me."
In the case of the HSEs quite simply because
a) they have no mechanism that seeks direct feedback about treatment effectiveness from their clients
b) their systems of care, recruitment, control and financial accountability are broken beyond any hope of repair
If standards were rising within the HSEs, I'd agree that self-praise might have value. However, as standards are demonstrably falling, they need to focus on client perception and expectations not indulge their internal Narcissus.
External 'client' feedback is a completely unrelated matter. To rule out inexpensive internal peer recognition programs such as this just because there is no external feedback makes no sense. Besides, there are existing user feedback systems in place, never used them, but they're there.
Agree there, it's a mess of multiple antiquated systems all jumbled up and thrashed out with unions over the years so even those trying to work with it day to day are left frustrated and demotivated.
It's when standards are falling that the need for such systems is greatest.
I'm no fan of the HSE, I think it's a complete administrative and logistical mess that wastes vast amounts of taxpayer money. Attacking everything they do regardless of merit isn't likely to encourage anyone to try fix it from within.
The only "thing" that gives an organisation any validity is its purpose - what was it set up to do - the end-product it was supposed to deliver to its clients.
I would venture to suggest that the purpose of the HSEs is "to deliver healthcare to the population of Ireland". How well, or indeed if, it does that can only be measured by their clients - the people to whom they deliver healthcare. Nothing else matters.
Systems which fail to deliver on their purpose will eventually wither and die. They will have no purpose and the first signs of this happening is when the wagons start to circle and those employed within the system will begin criticising their clients, their sponsors (government in the case of the HSEs) in fact their entire environment for their on-going failures.
In the case of commercial organisation they will eventually close or be bought up if they have products or other assets that might be valuable. In the case of the HSEs the alternative will be privatisation and the breaking of the unions whose playthings the HSEs have become. Neither Government nor what passes for management within the HSEs have been able to get control of the monsters they have become. Money hasn't fixed the problems, multiple "restructurings" have failed and all the trophies awarded to each other by staff internally won't change what the organisations have become. They will be closed and the work (not the facilities, not the management, not the personnel with their current contracts) will be will be undertaken by private enterprise.
My family and I have been clients of various health boards and HSEs for decades. Not once has anyone approached us to provide feedback on how we experienced the services provided or if we saw any opportunity for improvements or if our expectations had been met. The arrogance is just mind-boggling.
Seeking feedback about effectiveness (how well it achieves its purpose) is expensive for any organisation. Not doing so as we are seeing with the HSEs is unmitigated disaster.
I would venture to suggest that the purpose of the HSEs is "to deliver healthcare to the population of Ireland". How well, or indeed if, it does that can only be measured by their clients - the people to whom they deliver healthcare. Nothing else matters.
Systems which fail to deliver on their purpose will eventually wither and die. They will have no purpose and the first signs of this happening is when the wagons start to circle and those employed within the system will begin criticising their clients, their sponsors (government in the case of the HSEs) in fact their entire environment for their on-going failures.
In the case of commercial organisation they will eventually close or be bought up if they have products or other assets that might be valuable. In the case of the HSEs the alternative will be privatisation and the breaking of the unions whose playthings the HSEs have become. Neither Government nor what passes for management within the HSEs have been able to get control of the monsters they have become. Money hasn't fixed the problems, multiple "restructurings" have failed and all the trophies awarded to each other by staff internally won't change what the organisations have become. They will be closed and the work (not the facilities, not the management, not the personnel with their current contracts) will be will be undertaken by private enterprise.
My family and I have been clients of various health boards and HSEs for decades. Not once has anyone approached us to provide feedback on how we experienced the services provided or if we saw any opportunity for improvements or if our expectations had been met. The arrogance is just mind-boggling.
Seeking feedback about effectiveness (how well it achieves its purpose) is expensive for any organisation. Not doing so as we are seeing with the HSEs is unmitigated disaster.
I fail to see how any of that makes an internal recognition tool ridiculous. Particularly when that tool has nothing to do with end user feedback.
The feedback tools are available, if you feel so strongly, perhaps you should look them up and have your voice heard. Letting off steam here may make you feel better, but will change nothing.
The feedback tools are available, if you feel so strongly, perhaps you should look them up and have your voice heard. Letting off steam here may make you feel better, but will change nothing.
Believe me we have used them. They achieve nothing other than generate paper.
If the general population in the country doesn't know enough to stay away from A&E with 'flu and/or don't have or know about alternatives, how does a shiny plastic trophy exchanged between speech therapists or hospital porters in an area change that disgraceful situation? Shut the HSEs down. According to the Dail PAC they may even pose a very real danger to the people they are meant to care for.
If the general population in the country doesn't know enough to stay away from A&E with 'flu and/or don't have or know about alternatives, how does a shiny plastic trophy exchanged between speech therapists or hospital porters in an area change that disgraceful situation? Shut the HSEs down. According to the Dail PAC they may even pose a very real danger to the people they are meant to care for.
I think you have squarely struck the nail on the head with that comment. There has to be a better way to establish what exactly is an accident or emergency without the actual A@E department being the first port of call.
I cut my finger quite badly a few days ago. My hand slipped when I was slicing veg on a mandoline and I ended up with a long flap of skin hanging off the side of my finger from the top knuckle into the back of my nail. I know that doctors don’t stitch that sort of injury so I wrapped it up and went around the corner to the pharmacy. €20 on disinfectant spray, plastic stitches (steri-strips), a bandage and some pain killers and I was sorted. I did bleed all over the floor of the pharmacy but they were ok with that. If I’d gone to A&E it would have cost me €100 and 5 or 6 hours and I would have ended up with the same thing. OK, I would not have had to clean and dress the cut myself but so what. I don’t understand why people go to hospital for minor injuries and the like when they should be able to sort them out themselves. Should we teach first aid in schools? Would that help?
My local doctor used to have a walk in clinic, but no longer operates it. Sometimes you have to wait days for an appointment. Now, instead, I regularly go to the chemist for minor ailments for myself and my son. Our local chemist is lovely, private consulting room , free of charge, no need for an appointment.The things I have gone to the chemist with were, a suspected veruca on my sons foot. One of the staff members had training in foot therapy. She examined it in the private room and said it was actually a corn, for which she gave me treatment. I have also had one of my children in with hand, foot and mouth disease. No treatment available for this, either prescription or non-prescription, advised to wait it out which we did. Also, I went myself with a sore eye, drops given by chemist, which cleared it up. Of course, if a condidtion persists, I would go to GP, but its ages since I needed a doctor. I would love to see them be given a bit more responsibility, and recognition as a practical and knowledgeble front line medical person.
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It won't. It's not supposed to. It's completely unrelated so expecting it to do so makes no sense.
Gerry Canning
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mathepac, I like your comment on (mission) statements. AIB used to have them?
Leo, I also agree with you that in general mission statements, if enforced, help.
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A&E is driven by an uncertain demand ,and twits thinking their scratch requires immediate attention.
A&E needs to be taken out of (political/airways) cycle of unusual cases and we then decide do we tolerate the Saturday Night Drunks or the other resource wasters whilst trying to be fair ,
Its a tough one .
Leo, I also agree with you that in general mission statements, if enforced, help.
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A&E is driven by an uncertain demand ,and twits thinking their scratch requires immediate attention.
A&E needs to be taken out of (political/airways) cycle of unusual cases and we then decide do we tolerate the Saturday Night Drunks or the other resource wasters whilst trying to be fair ,
Its a tough one .
You keep missing, or ignoring, my key point. Any activity that is not aimed at improving the HSEs' services for the benefit of their clients is a waste of time, effort and money. Our money, my money. I can almost guarantee that the activities associated with the award of trophies occur during work-hours, just like the time and cost of reworking the HSEs' web-site for competition and awards was paid for by us.
@Marion that's a very useful web-site. Is there a link to it from the HSEs' main site or is it stands-alone?
There was Purple always talking, running the country, pointing his fingers at bearded ones and not concentrating at what he was doing and nearly mutilated himself with a kitchen mandolin. But, being probably afraid to show himself to some Public Service people, felt threatened and self diagnosed and self cured and saved himself some time, money and carpark fees, not to mention possible infection and the certainty of him pulling out his hair when he might see some thoughtless people in attendance of A + E just because it was "free" for them.
Next time Purple points the finger it will be a reminder of what can happen if not fully concentrating. To answer his question we should be teaching first aid in schools and perhaps minor injuries will cease to be treated in A+E.
I'm not, I have seen the benefit of similar low-cost schemes over the years for end users/customers. I'm not sure why you can't accept that the improvement of services to end users can be achieved internally, and provide much better value for our money.
Where did I say my examples related to health services? I don't work in the HSE, so don't have access to such information. Where I do work, they work really, really well. If you want to effect lasting change in any significant org, there's only so much diktats or schemes promoted from the top will ever achieve. Look at how Japan took over the manufacturing world through Kaizen and lean practices. They all embrace schemes such as these, done well they're a hugely cost effective means of improving the end product.