Not long ago, as I was presenting some findings from our work, one of the hospital executive said to me “do we really do that many outpatient appointments each day”?
This followed a series of other “do we really do that” questions during the presentation, which had covered a range of areas from length of stay and bed occupancy to variations in clinical behaviour. Even for those unfamiliar with the functioning of the NHS, some of the findings were deeply troubling.
At the end of the meeting, we decided to spend the evening double checking our work. All the numbers checked out just fine.
But I remained haunted by the looks of surprise we had during the meeting earlier in the day. Surely our two weeks of work couldn’t uncover so many jaw-drop moments for the people that had been running the hospital for several years.
I decided to ask a range of people in the hospital to see whether our findings were a surprise. The results of my informal survey were:
Executives had a good feel for how busy the hospital was relative to ‘normal’, but found it harder to conceptualise the scale of what happened – especially as they had more than one hospital site.
Nurses had challenges way beyond anything I would ever be able to comprehend, but recognised some of the patterns we had identified.
Doctors were typically most interested in the statistical significance of our findings. And saw several aspects that would need to be double checked.
Finance analysts were not surprised by the size of the findings, but had not seen the same patterns before.
The car park manager had some time to talk and was the least surprised of anyone with the findings… not only did he think the numbers looked reasonable, but also recognised the patterns – “Tuesdays are always busy, but there’s always loads of space on a Friday”.
Why the lack of consistent information? Aren’t hospitals meant to have good information that is shared? Or shouldn’t there be better communication between different parts of the hospital?
Is it more problematic that theatre staff are spending a third of their day waiting to do an operation (rather than doing an operation), or that these isn’t consistent information about this problem?
Of course, even the smallest of hospitals are huge. And with the complexity of their scale comes a real challenge for managers trying to see what is happening and to think strategically when there are so many urgent problems to solve.
Perhaps it is time to have a word with the car park manager?