Are you trying to standardise care delivered to patients on the NHS?
Are you trying to improve patient safety on the NHS?
Are you trying to reduce mortality in the NHS?
Are you striving for clinical excellence?
If you answered yes to all of the above, you have come to the right place to be disillusioned about your search for the holy grail, the magic bullet, the fountain of eternal youth and such.
Now, Let us find out what kind of person you really are…..
Have you used the words "patient safety", "patient-centred care", "innovate", "radical thinking" or "action plan" more than twice in the past week with patriotic zeal?
If you have, you are a manager. You are ready for treatment.
If you think you are a clinician, you have been misled. Memory clinic services are not provided at this site. You are a manager. Welcome to therapy.
But before treatment can begin, let us find out what your personality is really like.
Do you like to use pathways?
Do you like to make guidelines?
Do you love to print out protocols?
Do you croon over colourful flow charts?
Do you have a nice flutter in your belly when you hear the word framework?
Do you glow with enthusiasm at mention of the word "care bundle"?
If you answered yes to the above, you are just the kind of person who should be in therapy.
Read on, it is therapeutic…
Let us consider the following scenarios:
Has a patient put in a complaint that his pain was not treated while in hospital?
Was the patient waiting for 2 hours before being seen by a doctor?
Has a nurse not shown enough compassion?
Has the surgeon been rude?
Was the water cooler not filled?
Shock, Horror. Yes. Something needs to be done. So where do we start?
Get some people together for a start, to have a chat. Committee. Done. RCA- root cause analysis. Easy; many nurse-hours later, the root cause of the problem is very evident.As usual, communication and information access are blamed. Solution: Even easier. Yes, you guessed it. We need a guideline. The chairman/ chairwoman sighs. Finally. A solution. Answer to our prayers. One of the arrogant ageing clinicians on the committee said something about addressing the real problem. He just does not get it. He is the real problem. If we could have a guideline for that we would!
People head off in different directions from the committee to make up a guideline. There are thousands of guidelines out there on the internet as well as on billions of dead trees, produced and updated every other hour by NICE, royal colleges, speciality organisations, patient safety agencies, and about 300 other NHS hospitals, but no, we have to have another one that is very individualised for our hospital. Why? Because our patients are different. They have 3 ears and 4 noses. Not like those in the other SHAs. So we adapt the guidelines to fit the local ugly population. This intricate business usually involves removing two commas and adding an extra arrow at the end of the flow chart. A hyperlink to "see trust document in some other obscure place" truly personalises the document. Hand-rubs of glee and five other committee meetings later, a colourful guideline with two extra commas and one arrow make it to the elite clinical governance committee's table. No clinicians there, but thanks to the Health care assistant who popped in to clear the floor, they are quorate. Before you know you are in contravention of guideline Z.1.A.para 3 that is now available at location Z:\Patients\Dont care\Who knows where\too deep\got lost. Paper copies not valid. Electronic copies invalid. Newer version elsewhere.
Ok, so you cannot identify with that one. You are still deeply lost in your managerial role with no insight and trying to find the hospital where you work at. Let me empathise with you for a moment. Let me put your hat on and get into your shoes. Let us exchange whole wardrobes. Looking from your point of view, I can see that guidelines are helpful. I suddenly realise that the advantages of having a guideline is manifold.
Firstly, you have a sense of accomplishment. Something has been done. It is a totally different feeling. Man, I feel like a woman. (Oops, shania twain fan, that is all. )
Secondly, you have an object that you can refer anyone who is unhappy about the problem, to. You shout: “See rectal itching guideline please”. Two birds with one stone. Ahem.
Thirdly, You can tick the box under the "action plan" bit. Yup. Life changing. Life giving. Life saver. You!
Fourthly, You can put it on your year-end appraisal. Quality improvement Project (QIP)? Tick.
Fifth, Apply for clinical excellence awards. If guideline making is not clinical excellence, I am not sure what is. Wait for guaranteed cheque.
Sixth, Tick national questionnaire; “Does your trust have a guideline on toe nail cutting”? Proudly present your offering in shining pdf with glossy flowing pathways which will quell any further queries.
Seven, Forward said document to any chap making freedom of information (FOI) requests about how the trust is dealing with the current problem with increased mortality. You are worth your weight in goldline, I mean guideline.
Eight, attract more trainees to hospital as they will be able to train in a hospital which has a guideline on everything known to man and some more. Publish adverts on deanery websites that go along lines of: "Choose our hospital for your speciality training. We have got your training fully covered. We even have guidelines on how to use the guidelines. Because we care."…. Well, about guidelines anyway.
If the above has sold guidelines to you as the best thing since sliced bread, I think it is high time you tried cereals.