Gamekeeper turned Poacher

I had minor surgery today courtesy of the Day Care Unit in Prince Phillip Hospital. Thanks for asking, it was for a small umbilical hernia and all went well. However, the point of writing this is not to play the sympathy card but to take the opportunity to reflect on how I saw the unit work from a couple of perspectives: quality and infection, prevention and control because of course, professionally, these are two areas that engage a lot of my time.

It was interesting to be able to observe first hand our health systems in operation. Systems is key to a lot of the quality driven processes, from the systems used for cleaning to the systems used for patient discharge. I can report, I am well impressed by the Hywel Dda machine. The environment is clean, tidy, with all furniture and healthcare items arranged in a neatly efficient way. A place for everything and everything in its place. Does this matter? You bet your sweet life it does! Aside from the basic infection prevention/hygiene issues, in my view, the science clearly shows that everything that creates confidence in the patient will have a positive effect on their health and wellbeing, including effects on the immune system, important to promote wound healing and prevent infection. If you want to know more about these effects, take a look at the post I wrote some time ago.

So having arrived and taken in the first impressions, which also included the professionalism, courtesy and friendliness of the staff, which again has that positive psychoneuoimmunomodulating effect (isn’t that a great word?), we got down the the business of admissions.

People generally find forms tedious; I do. But in this context, what the staff were doing was very important and comes from a load of learning over the years.  Much of this has been encompassed in the 1000 lives plus activities. Checklists stop important items being forgotten so that error can be avoided. We’re human so we err and checklists seek to prevent this. We don’t go out of our way to do a bad job in healthcare but with a thousand and one things happening, if we don’t have appropriate prompts, we will be more prone to error.

My surgeon and anaesthetist came and gave me the once-over and explained all that would happen. They knew I knew this but rightly, they chose not to assume. Yes, we had a bit of banter because we know each other from our normal clinical interactions but they went through those elements that needed to be clarified. 

I changed, had my pre-med, went through further checklist items, including the 4th and 5th handover with me agreeing who I was and what I was about to undergo. And I woke in recovery with personal attention, checking, assessing and finally wheeling back to the unit where I met the afternoon staff, who maintained the same high standards of care.

So please feel free to share this with the huge number of people who were engaged today to ensure everything went like clockwork. Now the problem with creating a list on the fly is that I fear I may miss someone out; let me therefore apologise upfront but if I have missed someone, tell me by commenting below and I will ensure I put that right:

1. The Hotel Service staff who are responsible for the beautiful clean state of the environment. I know we have some amazing technologies available now with microfibre and the attention to detail you use amazes me. I saw you doing the surface decontamination.

2. The reception staff, first point of contact and oh so important to put our minds at rest, yes, we were expected and please take a seat, the nurse will be with you shortly.

3. The nurses. I apologise as I am using the term generically here to include the health care support workers, the trained nurses, all the way up to the nurse managers making sure everything was running like clockwork, which it clearly was.

4. The portering staff who came with me, again with smiles, positive messaging; you are not just about pushing us around, you are helping our health and well-being.

5. The operating department assistant (ODA): you were my eyes and ears in the theatre, talking with me and the anaesthetist; looking out for my wellbeing, explaining what would happen next.

6. My anaesthetist: at this stage of course, things start to get a little blurry! From here on in I am now reliant on who I know has helped in my interaction with your service.

7. The scientists who work in the Hospital Sterilisation and Decontaination Unit (HSDU): these guys are responsible for the high quality sterile instruments that were used during my surgery. I was reminded about this team because the day case unit undertakes endoscopy and a clean endoscope was being delivered to the unit from the HSDU. This was a unique change in Prince Philip Hospital when it was introduced. Until then decontamination of endoscopes was undertaken in the department. Now the processing is carried out in HSDU using their quality systems (there’s that word again.) The health board has introduced this same change now in Glangwili Hospital.

8. The theatre team: nurses, nursing assistants and again, those cleaners. They will have ensured the theatre is a safe environment, laid out the new, clean instruments having seen the previous dirty instruments flow out via a separate route.

9. The pharmacy team: responsible for maintaining safe and consistent stocks of every drug required to ensure I am as well as I am now, writing this at home.

10. The estates department: thank you guys, there were a number of engineers who were working within the department and passing through the day care unit. They had a job to do but they too as they passed through the department were very conscious they were in a clinical area, were quiet and non obtrusive.

11. The catering department: a late sandwich lunch was available for me, once I was back on the unit

12. The managers: the ones who probably get the most stick but let’s be clear, quality service provision needs a lot of other non clinical engagement: the managers in scheduled care (in my case) but every section has a set of managers who are responsible for ensuring all the above runs smoothly: these include procurement, finance, training, policy writers and this is probably where I go wrong as noted at the start.

Let me summarise: this is a well oiled, well trained, well drilled, efficient quality service and I enjoyed my interactions with you all today. I appreciate that there will be others who get hurt and damaged when things go wrong and I apologise if I therefore offend you with my story. When things go wrong, there is another machine that swings into action to try and understand the issues and refine the systems. They must be constantly refined so mistakes can be prevented. That said, the vast majority of patients going through the NHS will have experiences similar to mine and that is worth celebrating.

Thank you team and Merry Christmas.