When two tribes go to war…

Of all that has surprised me since starting work in Rotherham, the biggest has been the whole thing to do with the patients – who they are, which population they represent, and which hospitals provide their care.

For those of you unfamiliar with the geography of South Yorkshire, here is a map:

S Yorkshire

You can see how very close to one another Rotherham, Doncaster, Bassetlaw (Worksop), Barnsley and Sheffield are, each with either an associated teaching or district general hospital.

Socioeconomically the area is not that diverse – those families previously supported by mining and the steel industry are coping with the post-industrial fallout. Each area has its wealthy, many of whom live on average ten years longer than those in the poorest wards.

life expectancy

It is a microcosm of the UK.

Because of the proximity of the towns and city, there is great overlap between patients, hospitals, councils, GPs and other facilities.

People on the same street might have GPs who work for different commissioning groups; from one road to the next the bin-days and recycling rules differ as do the school holidays.

You might call it a mishmash. A hodgepodge.

I believe the Greeks called it a Megalopolis.

All of this is interesting if you are an epidemiologist or social scientist.

I’m looking at the nitty-gritty. The granularity – in other words, the patients.

Person A, B or C – Albert, Belinda and Colin.

The patients, like the school children or the bin-men don’t discriminate, particularly when there is an emergency. An ambulance is called and, you are taken to the nearest available A&E.

Because of logistics and hospital waiting times in particular, you might be taken to Doncaster Royal Infirmary on Monday when you have a stroke, then two weeks later when you slip in the bathroom find yourself in Rotherham, or Barnsley. You might have your heart surgery in Sheffield and receive treatment for heartburn in Bassetlaw.

And, if you read my two recent blogs, you will know what is coming next… None of the organisations have integrated systems; they aren’t quite at war – beyond that, there is so little interoperability that results, treatments, investigations aren’t shared.

And, all of this is made worse by the chaos of a health service that is being choked at source, which results in doctors and nurses working at double-time, without capacity to take the long-way around, go to source and find-out exactly what happened during the recent visit to the neighbouring hospital.

Please note – I am not calling for us all to merge into one big uber-organisation, as, what I have experienced is that the bigger these places get (hospitals) the more impersonal the care, the lesser the experience of both the staff and the patients.

Maintain your identity, localness. Preserve the Barnsley Chop (and accent)!

Mrs A who lives in Rotherham is equally a patient of Doncaster, Bassetlaw, Sheffield or Barnsley hospitals.

Consequently, we must all be working to the same or as equivalent as can be achieved, standards of care.

If I admit patient G (Gavin, Graham, Georgina?) to Mallard Ward in Doncaster, where no patient has experienced a pressure ulcer in something like 1500 days, I take exquisite care of their wellbeing and skin and, the nurses, healthcare assistants and therapists all work together in harmony to provide the best experience possible and, G, G or G then goes home and two months later develops a pressure ulcer within 24 hours of admission to a different ward with different quality, different standards, different staffing, then, all that effort on Mallard, was, to some extent wasted.

And, here I am getting to my point.

The tribalism.

And I will be brutally honest about this, as I feel the experience for the patients is not right.

Some areas, caring for certain patients will discourage staff from working or moving to other hospitals. They will say, ‘keep with us, we are the best in the area.’ That, I guess is OK if it is true. If however it is not true and you want to coerce people into staying or frighten them from going elsewhere that is not.

Don’t go to that place over there – because of all the kerfuffle with reorganisation of health and social care, they are going to close it down. Stay here. We are the biggest and best. Leave them. They will be OK and, what happens to them doesn’t matter; stick with us, we are your tribe, your clan. It’s all the same NHS anyway.

Yet, what I have just described is all of the organisations being within the NHS, but in relation to consistency of standards or experience there is variation and, whenever unwarranted variation is present, outcomes will be different.

Hip surgery in hospital A has a 1% wound infection rate. That is all very good, until you hear that in hospital B it is only 0.05% and you happen to be in hospital A and your wound is infected.

This is a difficult subject and I am not saying that those places that are well staffed should give-up folk to work in those that are less-so; I remember a very frosty email I received from a former professor of cardiology when I suggested something similar many years ago… Asking for equity was not what he wanted to hear. I think things changed after my knuckles were rapped.

Perhaps it is openness and transparency.

Perhaps it is people taking a stance and looking at the state of staffing and resources, perhaps it is saying to one another, ‘Let’s overcome this tribalism – for the patients’ sakes.’

If patient A is admitted to hospital B with condition C, their outcome should be as likely to be good as were they admitted to hospital D. Surely this is logical. And how do we achieve this equality? We look at staffing conditions and numbers, nurses, doctors, therapists, pharmacists, managers, technicians – determine which place is most efficient, most effective, share the learning and work together.

Who is the positive deviant?

Learn and share, engage, interact and communicate.

Take off the boxing-gloves and share a cup of tea or coffee – whatever your preference.

spitting image.jpg

 

2 thoughts on “When two tribes go to war…

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s