Back in ancient times, when I was applying to medical school, my first and most memorable interaction with the modern medical world occurred at my first interview. Somewhat bleary-eyed from a research laboratory party which went later than expected the previous night, I proudly donned the only suit I possessedpurchased specifically for this occasion and not yet properly fitted, but grabbed nonetheless as I had nothing else to wear to the interview. Yet, with an air of confidence spiced with terror, I marched into the interview only to receive a welcome that one might expect in a fish market
from the fish. And then came the first questionmy moment to shine: “Design me a hospital.” Did I get that right? Design me a hospital!!! Here I am armed with neat packets of information about what a great doctor I would makesound bites designed to answer any question about any aspect of my record or life. And this guy just asked me to design a hospital??!!!
Actually, the question was not so bizarre as it seemed at the time. In fact, it could even be viewed philosophically as how one views healthcare. The sad reality is that the vast majority of hospitals are designed in order to facilitate the conduct or business of the hospital, but not to fulfill its ultimate mission. Yes there are patient rooms and operating rooms and recovery rooms and waiting rooms and laboratories and administrative officesperhaps doctors officesand all the accessory necessities of food service and gift shop. But in the competing demands of organization, the experience of the patient is frequently the last and least compelling priority. They are usually faced with the demands of registration, financing and instructions to go here or there, and always the ubiquitous waiting. One wonders if one had such brusque treatment at the local restaurant just how long it would stay in business. But this placethis medical “Mecca,” is going to save your life, or, at very least, heal you – so you really have no choice but to put up with the system.
As a third year surgical resident I had the misfortune/good fortune to become a surgical patient in the hospital at which I was training. This experience proved to be the most elucidating of my entire lengthy residency. Even though, as the ultimate insider I had the privilege of choosing my doctors, my nurses, even my room. I also had the ability to call the labs, find out the operating room schedule, and summon the assistance of the army of my surgical resident colleagues. Yet, sure enough, when I checked in, unable to walk, the admitting clerk would not permit me to go to my room until I gave a credit card guaranteeing my bill. The fact that I was an employee of the hospital and they could therefore garner all of my wages didnt seem to matter. So I walked away and went to my room, where I was promptly visited by security seeking my signature and credit card number on the waiver
Before any health care facility is constructed, the planners should imagine themselves sick and in need of help. They should design the flow of the system as they would want it to occurhow can the building be constructed to place the patient at the center of all activity? What would be easiest, most convenient and kindest for his needs and the needs of his family? Signs should be clear, transport minimal, environments warm and friendly. What does a patient see on the ceiling as he is being wheeled in the gurney? What does he hear and smell? What has been done to preserve his privacy in a non-private place? Is he sent or taken? Are people harried and overworked, or calm and inviting? Is communication clear and forthcoming or cold and evasive? Ultimately, “management” of a healthcare facility means management of its mission to provide “health care”. We all have a long way to go
Post Views: 990
