As many people would know, I have had to spend some time in hospital over the last week. We live in an incredibly lucky country and at no stage did I have any concerns about my health and I knew that I would be cared for. From my fellow racers who stopped immediately after my crash through to St John Ambulance and the Ambulance Service of NSW all the way through to the staff of the hospital, I felt total confidence in being given a high level of service.
What I did notice with my personal experience going through the hospital system is a problem that all large organisations need to work hard to prevent. I have seen it in Federal and State Government departments; I have seen it dealing with large corporate organisations and I even see it with Councils. The silo effect.
I believe every person in the organisation was doing their individual best to help me. Unfortunately, various departments were not very effective at communicating with each other. Sometimes communication within the one department was lacking. I also noticed systems that have developed over time for a range of logical reasons – but with no-one having visibility of the overall process, many inefficiencies have crept in. None of this severely compromised my health care but it meant that the cost to the State was much higher than it needed to be.
The first inefficiency I noted was when the Ambulance drivers delivered me to hospital. I was delivered safely to the hospital and checked in to the Emergency Department but still the Ambulance staff waited beside me. I thought they were being incredibly nice and were staying and chatting to me. As we talked, I found out they just wanted their bed back! When I was loaded onto the Ambulance bed, it was used to bring me into the hospital. It was over an hour before I was transferred to another bed so that was an hour that these two staff members were not in the field helping someone else – all for the sake of a spare bed. I asked if they had ever considered a system where a hospital has spare beds for Ambulances to take when they deliver a patient to hospital. That would have the Ambulance drivers back in the field sooner. The answer I received related to what budget the purchase of spare beds would come from. The hospital doesn’t want to pay for them as it doesn’t have an impact on their efficiency and the Ambulance service doesn’t have the spare resources for additional capital outlay to store beds at hospitals. Classic silos. This is despite the fact that it would put the Ambulance drivers in the field where they are needed. They told me one story where their entire shift was spent at a hospital as they delivered a patient to a busy hospital and waited for the rest of their shift before their bed was returned to them.
Once checked in there was argument as to whether I would be under the care of trauma or neurosurgery or orthopaedics. My injuries meant I could be checked in under different areas. I didn’t really care which area had me under their control but this issue was a matter of intense debate amongst several staff.
After twelve hours in the Emergency Department – and with different people telling me different things in relation to my injuries (you have two fractured vertebrae quickly changed to three vertebrae after someone new looked at the CT Scans but seemingly staff didn’t speak to each other) – I was finally moved to a ward. The physiotherapists turned up the next morning to help me take my first steps but they were too early. The neurosurgery team had to give me the all clear to walk first and they hadn’t visited me yet. The physios promptly left – never to be seen again!
When it was time to have my new neck brace fitted, the waste of resources seemed ridiculous. I had three ladies arrive to instruct my wife how to fit the neck brace. The only issue was that I hadn’t received my discharge neck brace yet – I was still wearing the Ambulance fitted neck brace. It apparently wasn’t appropriate to use this neck brace for the instructions. Sometime later, a pair of gentlemen showed up with my new neck brace – but they couldn’t show my wife how to fit it as their job was simply to deliver the neck brace. Several hours later the team of three arrived again to show my wife how to fit it – and Murphy’s Law dictated they arrived just when my wife had gone to the shop! Once my wife returned, the five minute instruction was given. Over a span of half a day, it took five people a total of three visits to show my wife how to fit a neck brace.
Surely we can do better than this.
Again this may sound critical of the largest hospital in NSW but when a hospital has 855 beds; 23 operating rooms and 60 critical care beds administrative processes can often get in the road of the primary focus of providing care. As we all strive to be ‘Fit for the Future’ and with buzzwords like sustainability and viability being constantly thrown around, taking a few steps back and looking at a process in a large organisation can often deliver significant efficiencies.
Tell me your worst example of an organisation that has silos that don’t communicate with each other at mayor@dubbo.nsw.gov.au