Roy Mundheim | September 28th, 2017
Have you taken the “My VCH” Survey that came out recently? Are you optimistic for the result of being heard and of the prospect of positive change? I completed the survey two days after it was released. I was a bit disappointed to not see more opportunities to elaborate and comment on what “My VCH” experience has been like and what my ideas are for change. When the first e-mail came out announcing this survey, I was skeptical and apprehensive. However, as I read through it and saw phrases such as “transforming culture,” “finding new ways,” and the need for “a different approach,” I started to have a vision of my voice being heard. We all want to improve our workplace and be better at what we do. Although feeling some disappointment in the survey itself, I like the idea of having our voices heard. The opportunity to share my views and a few ideas is a great place to start.
Workload and Staffing
“Clients don’t come first. Employees come first. If you take care of your employees, they will take care of your clients.” – Sir Richard Branson
It’s no secret that workload is an ongoing issue for nurses and healthcare workers all over North America. Doing more with less is an ongoing change that never stops or even slows. Nursing is difficult and challenging work where there never seems enough time to do all that is ‘required.’ Prioritizing is an essential skill that often leaves some patients feeling neglected or unimportant. “What if” nurses and care aids had the resources, time, and opportunity to provide timely care for everyone? “What if” nurses and care aids could finish their work and leave their shift feeling that everyone’s needs were met? That’s the hope and vision I have for my work and the work of my colleagues. That is why I took the survey and why I’m writing this blog post. How do you see your workplace? What would you improve if you could?
My Crazy Ideas
When beginning the survey, I was excited (and scared) to share my crazy ideas. I focused on the fact that innovation, culture shifts, and new ways of doing things often come from crazy ideas. I have those!
I would add more staff to our hospital floors (No. This is not my latest edition of ‘Humour in Healthcare). I work with the elderly who are acutely ill. I therefore regularly rely on my colleagues to help me, at times guide me, and even to sometimes forgive me for the things I just couldn’t get to due to other priorities. More staff means better assignments, positive feelings of a job well done at the end of the shift, staff wanting to come to work, and a supportive, safe working environment. Ultimately, this impacts patients in a positive way, where all their needs can take priority. How about a little time to comfort, to teach, to be, or even take a bathroom break?
People are coming into hospital sicker and more frail than ever before. The elderly outnumber children in Canada for the first time in recent history (Statistics Canada/Census 2016). This trend is only going to increase as baby boomers get older, leave the workforce, and enter various stages of chronic and acute health problems. Does skeleton staffing work? Does it give us as a society a sense of pride or shame knowing that our healthcare workers are often overwhelmed and struggling to care for our aging population? Could more staff add to efficiency and ultimately to money saved? I do believe there would be better staff retention, less burnout, less injuries, less sick calls, less overtime, and a healthier workforce. That’s just this one nurse’s opinion. People way above me can discuss and analyze the merits of that idea.
B.C. Residential Care Survey
Recently, the Office of the Seniors Advocate’s B.C. Residential Care Survey released their results. Over 22,000 people in almost 300 long term care facilities were surveyed. What do you think were the results? To generalize, there were many positives while also having areas that needed much improvement. The recommendations based on the findings included improving flexibility around how and when services are delivered and increasing staffing levels. I think a survey of the hospital’s patients and front line staff would yield similar results.
Connecting the Dots
My next off the wall idea would be to improve transitions for patients. “Seamlessness” is not a word I would use to describe our health system. It would be great to see VCH take a giant leadership role in moving forward with a smoother, more continuous system. I recently read about a hospital in Sweden that have redesigned their stroke pathway to get patients triaged in the ambulance, bypassing the emergency department, and going straight to diagnostics. They changed the way they were doing things and have seen improved results and less stress on their system.
I’d like to see ‘admission nurses’ caring for patients in the emergency department and, when ready, taking them up to the wards. Charts will have been started. Medications given and on-going treatments would be clear and uninterrupted. That would be followed by a smooth hand-off to the accepting ward nurse (seems better than receiving information via a fuzzy black and white fax that doesn’t even make it to the ward until the patient arrives).
My final crazy idea is to stop running the hospital on “banking hours” Monday to Friday 7-3, 8-4, 9-5. While you may argue that the hospital runs 24 hours a day, it’s a skeleton staff on the wards. Patients don’t all sleep at night and they can be just as sick at 2:00 am as 2:00 pm. Admissions happen at any time (seemingly more frequently once unit clerks, management, and care aid support have gone home for the night). There are less nurses, few managers, less care aids, less doctors, and very few allied staff (physiotherapists, occupational therapists, speech language pathologists etc.) to deal with on-going patient issues on the weekends or nights. Nurses have more patients, more paperwork, and less care aid help on nights as well. Why is that?
I know my ideas are off the wall and crazy. Maybe you have a crazy idea too? To innovate and re-evaluate how we’re doing things we can’t be afraid to put ideas out there. I’m proud to be part of VCH because I see colleagues working hard through adversity, finding new and better ways to do things, and bringing their enthusiasm to every challenging situation. I know there are front line staff with great ideas just needing the chance to be heard.
Be Part of Positive Change
I would like to challenge everyone to complete the survey and look over the results. Let’s strive for innovative ideas, new ways of doing things, and solution-first strategies that can make our work better for employees and patients. Change is coming and it’s up to us to decide how positive that change will be.
Note: Releasing Time to Care, Quality Improvement Project
I am privileged to be a ‘ward lead’ for Releasing Time to Care, a self-directed, module based quality improvement project originally developed in England. Thanks to the generous donations of Robert and Greta Ho, Vancouver Coastal Health has been able to support staff in improving the efficiency and efficacy of their workplace. I’m proud to be involved and hope that by soliciting my co-workers for ideas, we can challenge the status quo and implement new and innovative ways to solve problems, save time, and maximize patient care. Learn more about the project in this VCH news article.