Bricks and Mortarboards

(A contribution to Patient Safety Learning’s ‘The Hub’. Get on board and join in the discussion)

When you enter a hospital, be it as a patient or a member of staff, an interesting thing happens. The glass doors close behind you and you are irretrievably in a different existential space. Outside, beyond that threshold is the material world. But inside you are a new Jonah having been swallowed by a mammoth whale I’m interested in exploring that existential space in the interests of quantifying the healing environment. I guess my theory is that healing doesn’t start in the ward or the operating theatre or the ICU.  It starts in the corridor. There is so much happening in that simple shared space. It is where a hospital really declares itself. The patient information plastered on the walls challenges patients to believe they are under-qualified; The labyrinth reminds them that they are novice travellers in a stark strange world; Conversations overheard, sights and sounds and smells all contribute to the feeling that they are trespassing in a world beyond their control and understanding. What does being in a hospital corridor speak of to you? I’m going out on a limb, here.  I’m going to say that as hospital employees, we are taught jobs. We are not taught how to be custodians of a shared space that aspires to heal. The way we converse in a lift, the way we smile, or not, at strangers and the way we stop, or not, when we sense that someone is lost, all counts towards the metrics of an organisational culture. Healing is a subconscious process as well as a physiological one. Engagement starts with the sum total of all these inputs, and whether that sum total is positive or negative. I’m happy to be wrong about this, but I’m equally happy to be right. Share your experiences and thoughts and let’s see how powerful the lived experience is in comparison to just the bricks and mortar. Adrenaline is a phenomenal chemical. Patients marinated in endogenous adrenaline have a stormy Perioperative course.  Veins are hard to find, higher doses of induction agents are required, blood pressure is more labile, airways more reactive, post operative pain more resistant to standard therapy regimens. My feeling is that the hospital environment does little to dissipate this anxiety, and we could almost be accused of deliberately inciting anxiety by virtue of the patient’s lived experience. My feeling is that this big miss in the therapeutic experience could be said to be a major contributor to patient harm I used to always point out to friends that the doors to birthing suite had ‘push’ written on them whilst the doors to the caesarean theatre said ‘Pull’. But jokes aside, the subliminal rhetoric that greets us often says more than we hoped. For example, at my home hospital: the hospital entrance hand rub station completely empty of product day after day;  the splits in the vinyl of the waiting room chairs; the state of equipment and trolleys parked along the corridor, all scream of hypocrisy, reinforce that the patient and the respect owed to them of are insignificant matter, that though we preach infection control, that lesson should only apply when it is not inconvenient to do so, not universally at all time and for all people. I guess my question finishes up being: ”How can we pretend to meaningfully engage patients when right from the very start we create an invalidation and dys-equilibrium from which the consequence of patient harm will, with certain probability, arise? Pete!

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