A Culture of Service
During my two years as a fellow in Cardiovascular Surgery at the Mayo Clinic I have learned inumerable operative skills, advanced clinical decision-making, and advanced clinical judgement. However, this is only half the story. I have also learned about professionalism and have witnessed a culture of service towards patients that is not rivaled by anything else I have experienced before in a Canadian setting.
A culture of service is reflected in the mission statement of the institution. But it goes beyond this. The founders of the Clinic set the tone for it's future: "The needs of the patient come first" or "The interest of the patient is the only interest to be considered". However, it goes even further that words. What struck me most about the Clinic is that these words are paractised on a daily basis by all levels of employees of the clinic. Everyone is pleasant; everyone is helpful. I felt that there was truly a "culture" of service. It has a feel to it; it is in the corridors of the hospital and in the walls of the clinics. Patients tell you about it, as they express their pleasant surprise about how "different" things are here.
To be fair, much of this stems from the profit-based medical practise in the USA. A culture of service is a useful business model to attract and retain patients. It works in the hospitality industry and applies well to medicine-for-profit. However, I think that this should not detract form the benefits it provides the patient and their families. I believe that we should try to emmulate this "culture of service" in our Canadian health care system, despite our resource limitations.
Resource limitation is a reality in Canadian medical practise. It leads to healthcare worker fatigue and burnout. This is perhaps one explanation for the lack of culture of service, which I have witnessed. However, there are attitudes and behaviours that are not resource dependent. We can all be more polite and less rude to our patients and to each other. Pages and phone calls can be answered more promptly. Phrases such as “how may I help you” or “can I do something for you” should be said more often. Regardless of who we are, we can answer questions or find someone who can. Pain should be treated more expeditiously (there is no shortage of morphine). Call lights should not go unanswered. And it all comes from the top, down. If a consultant is the one who first goes to help a family member waiting at the nursing station, quickly others will follow.
Our attitude should change from one of “this is not my problem” to “how can we help this patient”. Nurses should say less “I am not looking after that patient” and more “let me find someone who can help you”. Doctors should say less “this is not a problem in my specialty” and hang-up the phone. They should say more “I think this is not a problem in my field, but have you considered…Maybe you should consult…What about trying...”. Our frame of mind should not be one of relief when a patient does not have to be admitted to our service, but one of concern that the patient have a proper diagnosis and get the appropriate care.
We have also shifted our minds into cost savings rather than patient care. I believe this has had the largest negative impact on the potential development of a culture of service in the Canadian healthcare. There are glaring situations that typify this attitude. For example, there is the request for radiological investigations at night, when resistance is encountered and questions as to whether or not the patient truly needs the investigation. The underlying attitude here is the protection of a microbudget, rather than the best interest of the patient. What is worse is that the determination of need is being made by someone over the phone who has not even assessed the patient. Another example is the guarding of intensive care unit beds. Whether or not a patient gets admitted to an intensive care unit should be criterion-based and not on arbitrary judgments that are influenced by bed availability. Again, the interests of the patient should be the only interest considered and the system must adjust accordingly. In essence, a culture of service should take into account that the patient takes priority over the existing budget.
By no means am I suggesting that resources should be over-extended. Judgments about the true need for an investigation or an admission to an ICU bed should be made at the consultant level given the limited resources that exist. These decisions should not be left to residents, nurses, or administrators. And if a consultant is going to withhold a resource that has been requested by another consultant, it is a reasonable expectation that they see the patient and the reason for the denial be documented by them in the clinical record.
How does one reconcile a culture of service with the limited resources of the Canadian health care system? American-style for-profit health care is not the answer. It can be done within the existing structure by accepting the FACT that resources ARE limited. We, as consultants, can change our attitudes and behaviours to reflect our belief that the needs of the patient and their families do come first. Others will follow. If the quality of the care you deliver is in direct relationship to the amount of government funding, you should not be a doctor. Furthermore, the “triage” of resources is too important to be left to anyone less than a consultant. As consultants, we should be at the patient’s bedside making the critical determinations about their care. Patients and their families should see and know that we are in charge of their wellbeing. It is here that the culture of service begins.
A culture of service is reflected in the mission statement of the institution. But it goes beyond this. The founders of the Clinic set the tone for it's future: "The needs of the patient come first" or "The interest of the patient is the only interest to be considered". However, it goes even further that words. What struck me most about the Clinic is that these words are paractised on a daily basis by all levels of employees of the clinic. Everyone is pleasant; everyone is helpful. I felt that there was truly a "culture" of service. It has a feel to it; it is in the corridors of the hospital and in the walls of the clinics. Patients tell you about it, as they express their pleasant surprise about how "different" things are here.
To be fair, much of this stems from the profit-based medical practise in the USA. A culture of service is a useful business model to attract and retain patients. It works in the hospitality industry and applies well to medicine-for-profit. However, I think that this should not detract form the benefits it provides the patient and their families. I believe that we should try to emmulate this "culture of service" in our Canadian health care system, despite our resource limitations.
Resource limitation is a reality in Canadian medical practise. It leads to healthcare worker fatigue and burnout. This is perhaps one explanation for the lack of culture of service, which I have witnessed. However, there are attitudes and behaviours that are not resource dependent. We can all be more polite and less rude to our patients and to each other. Pages and phone calls can be answered more promptly. Phrases such as “how may I help you” or “can I do something for you” should be said more often. Regardless of who we are, we can answer questions or find someone who can. Pain should be treated more expeditiously (there is no shortage of morphine). Call lights should not go unanswered. And it all comes from the top, down. If a consultant is the one who first goes to help a family member waiting at the nursing station, quickly others will follow.
Our attitude should change from one of “this is not my problem” to “how can we help this patient”. Nurses should say less “I am not looking after that patient” and more “let me find someone who can help you”. Doctors should say less “this is not a problem in my specialty” and hang-up the phone. They should say more “I think this is not a problem in my field, but have you considered…Maybe you should consult…What about trying...”. Our frame of mind should not be one of relief when a patient does not have to be admitted to our service, but one of concern that the patient have a proper diagnosis and get the appropriate care.
We have also shifted our minds into cost savings rather than patient care. I believe this has had the largest negative impact on the potential development of a culture of service in the Canadian healthcare. There are glaring situations that typify this attitude. For example, there is the request for radiological investigations at night, when resistance is encountered and questions as to whether or not the patient truly needs the investigation. The underlying attitude here is the protection of a microbudget, rather than the best interest of the patient. What is worse is that the determination of need is being made by someone over the phone who has not even assessed the patient. Another example is the guarding of intensive care unit beds. Whether or not a patient gets admitted to an intensive care unit should be criterion-based and not on arbitrary judgments that are influenced by bed availability. Again, the interests of the patient should be the only interest considered and the system must adjust accordingly. In essence, a culture of service should take into account that the patient takes priority over the existing budget.
By no means am I suggesting that resources should be over-extended. Judgments about the true need for an investigation or an admission to an ICU bed should be made at the consultant level given the limited resources that exist. These decisions should not be left to residents, nurses, or administrators. And if a consultant is going to withhold a resource that has been requested by another consultant, it is a reasonable expectation that they see the patient and the reason for the denial be documented by them in the clinical record.
How does one reconcile a culture of service with the limited resources of the Canadian health care system? American-style for-profit health care is not the answer. It can be done within the existing structure by accepting the FACT that resources ARE limited. We, as consultants, can change our attitudes and behaviours to reflect our belief that the needs of the patient and their families do come first. Others will follow. If the quality of the care you deliver is in direct relationship to the amount of government funding, you should not be a doctor. Furthermore, the “triage” of resources is too important to be left to anyone less than a consultant. As consultants, we should be at the patient’s bedside making the critical determinations about their care. Patients and their families should see and know that we are in charge of their wellbeing. It is here that the culture of service begins.
posted by Luis G. Quiñonez, M.D. at
11:30 PM
1 Comments:
I agree. Mayo teaches that each patient is a privilege not a liability. In an overworked Canadian system, every patient is seen as a burden - one more admission which requires more time and effort. We must learn to overcome this and treat each patient as if they were a friend, family member, or ourselves.
It is pathetic, that despite a socialist system, most physicians and other health staff are truly more worried about what time they will get to go home or when their break begins, rather than focussing on what really matters - the patient.
Post a Comment
Subscribe to Post Comments [Atom]
<< Home